ITK August/September 2015 - Issue 43

ISSUE #43 : AUGUST/SEPTEMBER 2015

P r a c t i c a l In f o r m at i o n f o r T o d a y ’ s Co m m u n i t y P h a r m a c i s t

IN THE KNOW

• NEW: Behind the Brand

• Be a Health Destination

• CPD – Breathe Easy

• 6CPA

• Partnership – The Three Gs!

• Product Insight

ARE YOU RECOMMENDING THE RIGHT PROBIOTIC?

The right strain?

The right dose?

The right storage? storage For the best results.

THE ETHICAL NUTRIENTS PROBIOTIC RANGE DIFFERENCE RECOMMEND THE RIGHT PROBIOTIC WHAT TO CHECK FOR



SYMPTOM CHECK:

THE ETHICAL NUTRIENTS DIFFERENCE • 100% researched strength, scientifically studied strains.

Is your probiotic the right tool for the job?

Antibiotics? Digestion? Medically Diagnosed IBS? Allergy? Immunity? Gastro?

General Health and Wellbeing? Kids?

• A broad range of solutions for a broad range of conditions.

There is no one-size-fits-all when it comes to probiotics.

• In-house testing shows our strains are compatible and work together to provide reliable results.

• Clinically trialled.

FACT: Probiotic research shows multiple strains and high dosing doesn’t always mean a better result. Ethical Nutrients uses the right strains in the right combination at the researched dose.



STABILITY CHECK:

• Probiotics are live organisms; complete care is taken to keep them that way.

Is your probiotic refrigerated to ensure bacteria remain alive?

Concerned about stability? Think shelf stored versus fridge stable.

• Temperature is controlled at every stage of manufacture, storage, in-transit and instore to keep bacteria alive.

• Comprehensive testing of every batch, every step of the way.

• No compromises on stability at the cost of quality. Probiotic stability the right way; not the easy way.

FACT: Heat and temperature variations cause probiotics to activate prematurely and lose potency. Ethical Nutrients probiotics are kept refrigerated at all times because it is the only environment with a stable temperature.



QUALITY CHECK:

• In-house manufacturing; no contract manufacturing ensures control over the whole process.

Is the brand an expert probiotic manufacturer that you can trust?

• Purpose built 40 million dollar TGA and GMP Australian manufacturing facility.

• Microbiology lab with three full time microbiologists.

• The Probiotic Experts for 25 years.

FACT: Ethical Nutrients have an in-house microbiology laboratory. Our probiotics are tested before, during and after manufacture to ensure quality probiotics throughout their life span.

WHEN WE SAY CONTROLLED, WE MEAN CONTROLLED OUR COMMITMENT TO STABILITY:

IHP3256 - 06/15

Controlled by experienced and qualified microbiologists during culture growth and production.

Controlled humidity, controlled temperature, controlled storage, controlled strength.

Next day delivery, ice-packed for protection from overheated delivery vans and inwards-goods store rooms.

Sold from the most temperature stable shelf in your store - your fridge.

The benefit to you: Condition specific, researched dose, live and healthy probiotics, every time.

Probiotics kept in the fridge at home are protected from heat and fluctuations in temperature.

YOUR NATURAL BUSINESS PARTNER

SUPPORTING YOUR STORE

STORE

EDUCATION Training evenings.

Full day trainings for Vitamin Consultants and Pharmacists.

TV ADVERTISING AND IN STORE PROMOTION

DEDICATED ACCOUNT MANAGERS

NATUROPATHIC SUPPORT

SERVICE AND DISTRIBUTION

Ongoing and seasonal TV support to educate and drive customers into your store.

Personal face to face support and in-store training.

Full time team of qualified Naturopaths for technical support.

Friendly customer service team.

Online learning modules.

Comprehensive point of sale to increase sales of key lines.

Reliable overnight supply = Fully stocked shelves.

Pharmacy and Health Food only.

1800 777 648

ethicalnutrients.com.au

ORDERS OR NATUROPATHIC SUPPORT

VISIT WEBSITE

HAVE YOUR CUSTOMERS HAD THEIR INNER HEALTH PLUS TODAY?

1 MILLION customers Australia wide Healthnotes ONE

Healthnotes l l l l l l

SMS Reminders Overdue Reminders Reporting Script Tracker GP Connect

$80/mth Billed Monthly No Contract

Healthnotes App l l l l l l

Push Notifications Order Meds Meds History Family Mode Message History

FREE until 31st Dec 2015

Healthnotes PPS l l l l l l

Clinical Interventions MedsChecks Diabetes MedsChecks Patient Record Leave Certificates

FREE until 31st Dec 2015

DISPENSE WITH THE OLD. SIGN UP WITH THE NEW!

Ph: (03) 8692 0015 www.healthnotes.com.au *prices excl GST **SMS rates apply ***0-500 push notifications free. 501+ push notifications charged 5c per notification

2

CONTENTS

the value of a brand

After Hours 68 Sydney Spring Carnival

Behind the Brand 49 AFT Pharmaceuticals - Maxigesic

Business 6 Pharmacists’ Role in Improving Bone Health 12 Business Profile – Wild Child

BY SEAN TUNNY

20 Partnerships – The Three Gs!

Editor, Gold Cross Products & Services Pty Ltd

32 Success in Sport, Business and Life!

24 Beware Market Rent Review Traps

4

42 The 6CPA While it seems a little unseasonal, Brisbane overnight minimum temperatures of 6 degrees is chilly, by north of the border standards.

As this edition of ITK is distributed to Pharmacies, we are very excited to announce a new initiative in this edition of ITK called Behind the Brand (BTB). As we worked on this initiative, one of the key underpinnings in business is brand value or equity. Fittingly, AFT Pharmaceuticals are our inaugural featured company for the BTB, please turn to page 49 to read a little more about the company and their leading brand, Maxigesic.

In considering the most powerful and valuable brand in the World, who would this be?

Well, if you answered Apple, then you are correct.

This brand is worth $145.3 billion, with brand revenue of $182.3 billion, which is astonishing.

So what is brand value? A brand includes the name, logo, image, and overall perceptions that identify the product, service and owner of the brand in the minds of customers.

This takes the shape of advertising, packaging, and other marketing communications, and becomes a focus of the relationship with health care practitioners and in turn consumers. In time, this brand comes to encapsulate a promise about the goods it identifies—a promise about quality, performance, or other dimensions of value, which can influence consumers’ choices among competing products. In dealing with dozens of direct and indirect partners in our profession each week through ITK, we strive together to ensure that the brand and the value attached to it is accurate and promoted.

We are pleased to announce a number of improvements to the look and feel of ITK from this edition. We also feature an informative Business Profile, Training, Business and Health editorials which we trust you will find of interest. Thank you to all the contributors, partners and supporters of ITK, wishing you an enjoyable read of this edition.

Best Regards, Sean Tunny Editor

BROUGHT TO YOU BY:

Health 4

Seasonal Allergies and Hayfever

14 Nutritional Advice to Boost Male Fertility Potential 26 Breaking Down the Misconceptions of incontinence

7

28 Be a Health Destination 46 The Importance of Promoting Immune Health

News 3 6CPA 34 Revive Your Pharmacist Only Medicines Section

Product Insight

20

55 Do You Want More Dispenses Each Day? 56 Medihoney 58 Betadine Sore Throat Care 59 Putting the PRO in Probiotics 60 Helping Your Customers Stay Well This Winter

Regulars 63 What’s New and Company News

24

65 60 Seconds with 66 Product Spotlight 69 Health Calendar 70 Business Directory

Training and Education 7

Breathe Easy

38 COPD, Asthma and Inhaler Technique

32

PLEASE USE THIS PUBLICATION TO KEEP YOUR PHARMACY IN THE KNOW EDITOR: Sean Tunny

0457 029 052 sean.tunny@goldx.com.au DESIGN: Megan Hibberd

0408 452 133 www.artbymegan.com.au PRINT & APN Print DISTRIBUTION: 1300 134 628 www.apnprint.com.au

PUBLISHED BY: Gold Cross Products & Services. PO Box 505 Spring Hill Qld 4004. Contact Jessica O’Connor – Email: jessica.oconnor@goldx.com.au. In The Know is produced for the information of Australian Pharmacists.

The presence of the logo of the Pharmacy Guild does not constitute endorsement of a product. The Pharmacy Guild of Australia accepts no responsibility for claims made by advertisers. Opinions and views expressed in articles do not necessarily reflect those of Gold Cross.

NEWS

6CPA

THE SIXTH COMMUNITY PHARMACY AGREEMENT

George Tambassis National President of The Pharmacy Guild of Australia

This is an important time for community pharmacies as we shift from the Fifth Community Pharmacy Agreement to the Sixth Agreement.

As many readers of ITK would know, the fiveyear Community Pharmacy Agreements have been around since 1990. Their dual purpose has been to promote the sustainability and cost-effectiveness of the Pharmaceutical Benefits Scheme, and ensure the viability of the national network of community pharmacies.

The Sixth agreement, known as 6CPA, commenced on 1 July and will run through to 30 June 2020.

The new Agreement recognises community pharmacy as an integral part of the Australian health care system. It enables Australia’s 5,450 community pharmacies and their staff to continue meeting the health care needs of their patients.

The Agreement encompasses pharmacy remuneration for dispensing PBS and RPBS subsidised medicines; wholesaler remuneration including the Community Service Obligation; the Pharmacy Location Rules; and Professional Programs and Services.

Importantly, in the Agreement the Federal Government has made clear that it supports the continuation of the Location Rules until mid-2020. These rules ensure that community pharmacies are appropriately spread across the country, meeting the needs of people for pharmacy products and services wherever they live. They are ensuring that wherever there is a community need for a pharmacy, there will be a pharmacy to meet that need.

mark-up on PBS medicines, will substantially delink official dispensary remuneration from the cost of medicines, making pharmacies less susceptible to the adverse impact of price disclosure. This is a positive measure for consumers as it allows the Government to press ahead with significant PBS reforms, which are bringing down the prices of medicines.

The 6CPA includes a significant increase in professional program funding. This has the potential to significantly enhance the primary health care role of community pharmacies.

Total funding for existing community pharmacy programs in 2015–16 will be in line with 2014–15, avoiding a budget cut that would have otherwise resulted in significant reductions in funding for programs such as DAAs and clinical interventions.

The $50 million Pharmacy Trial Program will enable community pharmacies to pilot

a range of new patient services, which will enhance their primary health care role with the opportunity for ongoing funding, following an independent assessment of their cost-effectiveness.

There will be up to $600 million in funding for new and expanded community pharmacy programs, providing the opportunity for pharmacies to transform and significantly broaden their role as medicines experts and primary health care providers.

The continuing, new and expanded community pharmacy programs will have a particular focus on services for Aboriginal and Torres Strait Islander peoples, and rural and remote Australia.

Overall, we have achieved a good outcome for community pharmacies in a difficult budgetary environment.

“These rules ensure that community pharmacies are appropriately spread across the country, meeting the needs of people for pharmacy products and services wherever they live.”

The new Administration, Handling and Infrastructure Fee (AHI), which replaces the GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

3

4

Health

Seasonal Allergies & Hayfever

By Nate Hentschel Pharmacist, B.Pharm.

While for many people, allergies are an occasional annoyance, up to 1 in 7 Australians suffer from more severe or chronic allergies1, especially heading into spring. Hayfever and allergies can exhibit all kinds of symptoms, and choosing the most appropriate product for treating the symptom is an essential aspect of community pharmacy.

Symptoms Symptoms can include nasal congestion, sneezing, a runny nose, itchy or watery eyes, and particularly sensitive people may get rashes or hives, especially from direct skin contact with an allergen. These symptoms can vary widely in severity from person to person and from day to day, and some individuals may only get one or some of these symptoms.

Treatment Options The best case scenario would be to avoid the allergen altogether; however, for people suffering seasonal hayfever, this is generally not possible, as the allergy is typically to plant pollens in the air. However, patients can attempt to minimise their exposure where possible — for example by staying indoors and keeping breezy windows closed.

For most people there are a variety of effective medications available to use in treating allergies, as outlined below.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

Health

Tre at m e n t

Opt i o n s

Oral antihistamines

Nasal sprays

Eye Drops

Antihistamine tablets are often the easiest option as most are now once daily formulations. Typically, for someone with generalised allergy symptoms, starting with a less-sedating Schedule 2 antihistamine — such as fexofenadine or cetirizine — is ideal, as they are minimal in adverse effects and relatively effective.

Response to antihistamines seems to be a highly variable and very individual trait, so if a patient feels like one particular antihistamine has not been effective, this does not rule out the option of trialling some of the other antihistamines.

Wherever possible, antihistamines are best taken before the patient is actually exposed to the allergen, as opposed to after the symptoms begin.

Nasal sprays can be a very effective option, particularly for people suffering congestion or runny noses. For severe runny noses, a short-term option may be using an anticholinergic nasal spray such as Atrovent (Ipratropium) which can be very useful for drying nasal secretions. Intranasal antihistamines are also a good option for patients suffering predominantly from rhinorrhea, as there is likely to be less absorption than oral antihistamines. Patients suffering from congestion in the short term may also benefit from a decongestant nasal spray, which will work very quickly; however, these are generally only used for a few days before they need to be stopped.

For longer-term management, intranasal corticosteroids are available over the counter and can help manage more chronic allergy symptoms. For people with seasonal allergies, starting a nasal spray before the allergy season can be beneficial.

Eye drops are a useful option for people suffering from itchy or watery eyes, and many combination eye drops also have an ingredient to help with redness, such as naphazoline. Because of the risk of rebound symptoms with ocular decongestants however, these products should not be used long term. Single ingredient anthistamine or mast cell stabiliser eye drops can still be an effective topical choice for patients suffering from ocular symptoms. In the case of eye redness or irritation, artificial tears may also be beneficial in stopping the eye from getting dry.

If all less-sedating antihistamines are ineffective, patients may also consider the Schedule 3 antihistamines, such as dexchlorpheniramine; however, these medications often have adverse effects such as drowsiness that are not ideal for some people going about their day-to-day activities, and this should be taken into account. For this reason, if once daily lesssedating antihistamines are not effective, an alternative may be to use a nasal spray.

Referral points While allergies are usually fairly clear cut, there are some cases where further referral to a doctor or other healthcare professional may be warranted. Thick or coloured mucous may require further investigation, as allergy discharge is often clear and runny. Asthmatics who also suffer from allergies may be at increased risk of asthma attacks, so a useful intervention for pharmacists is to ensure they have an appropriate asthma action plan and that their asthma is well controlled. Generally, if you are in doubt about the cause of the symptoms or suspect that the allergy may be more severe than what should be treated over the counter, a referral to a doctor or other health professional can help to rule out other causes before commencing treatment.

References AIHW 2011. Allergic rhinitis in Australia.

1

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

5

6

business

Pharmacists’ role in improving bone health

by Melita Daru Osteoporosis Australia

Poor bone health is an issue nationally, with osteoporosis affecting over 1 million Australians and a further 6 million people with low bone density. The problem with weak bones is the risk of fractures, which have a significant impact on patients and on the healthcare system in general.

In 2013 Osteoporosis Australia released a new economic report, showing estimated fracture numbers are over 144,000 per annum. The expense of dealing with these fractures Represents the largest component cost for the disease over the next 10 years.

The important news is osteoporosis can be investigated, diagnosed and effectively treated to prevent fractures.

Pharmacists can play a key role in explaining the importance of calcium and vitamin D to maintain bone health.

Importantly, pharmacists also aid compliance with osteoporosis medications by explaining the importance of medications to patients.

As with many chronic diseases, osteoporosis treatment is central to managing the disease, and once diagnosed, prescribed medications play an essential role in the ongoing management of osteoporosis.

However, risk reduction is only possible with adequate compliance and adherence to medication.

Pharmacists remain a trusted source of information and the pharmacist can work with the patient to explain both the role of treatment in reducing fracture risk and the benefit of remaining on treatment, sometimes over many years.

The CEO of Osteoporosis Australia, Dr Greg Lyubomirsky, has said, “Adherence with osteoporosis medications is often poor, with patients discontinuing treatment for a variety of reasons. But education is the key to addressing this issue, and ensuring patients’ risk of fracture is reduced”.

Patients commonly query the benefit of medication because they cannot see or feel a positive change. But research has shown risk reduction across all available medications and it is important to communicate to patients that small increases in bone density can have significant benefit to reducing the risk of fractures.

Dr Lyubomirsky goes on to say that, “For too long there has been a public misconception that having a fracture is not a big deal, but for patients who have sustained a fracture, and as medical professionals in general we know, this is a big problem and something we should all be working to prevent”.

Pharmacists can also play an important role in identifying patients who may be at risk of osteoporosis by speaking with patients recovering from a fracture.

Currently, only approximately 20% of adults who come to medical attention for a fracture are then investigated for poor bone health.

Pharmacists can ask fracture patients if they have any prior history of fracture, or any family history, and encourage patients to raise this with their doctor. Investigating fracture patients with a bone density test is another important tool for combating the rise in future fracture numbers, and pharmacists can encourage this conversation.

Osteoporosis Australia provides a range of resources available online which can aid pharmacists when communicating bone health information to consumers, including separate consumer fact sheets on:

•• Medications •• Calcium •• Vitamin D A national toll-free number is also available for consumers with specific osteoporosis queries at 1800 242 141.

“Research has shown risk reduction across all available medications and it is important to communicate to patients that small increases in bone density can have significant benefit to reducing the risk of fractures.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

Osteoporosis Australia recommends that pharmacists are proactive in talking to patients about their bone health and in particular encouraging patients to adhere to medications.

For consumer resources, visit the resources page at Osteoporosis Australia www.osteoporosis.org.au

Training and Education

Breathe Easy: Helping Patients Manage COPD Tim Roberts Professional Development Manager, Pharmacy Guild of Australia (QLD) B.Pharm (Hons), AACPA, DipBusMgt

Chronic Obstructive Pulmonary Disease (COPD) is a largely underdiagnosed condition, however statistics show that approximately 1 in 7 (13%) of Australians over 40 are affected by the disease1. It is one of the highest leading causes of avoidable hospital admissions and after heart disease, stroke and cancer it is one of the leading causes of death and disease burden in Australia1. With the ease of accessibility of community pharmacy, pharmacists are well placed to help raise awareness of COPD through screening and referral programs as well as assisting diagnosed patients in optimizing their disease state management.

Learning Objectives After reading this article, the learner should be able to: •• Recognize the clinical features of Chronic Obstructive Pulmonary Disease (COPD) •• Identify contributing factors to COPD •• Recognize the role of pharmacological management strategies in COPD •• Identify comorbid conditions commonly associated with COPD

Competency standards addressed (as defined by the National Competency Standards Framework for Pharmacists in Australia): 6.1, 6.2, 6.3, 7.2

Accreditation number: A1508GX This activity has been accredited for 0.5 hours of Group 1 CPD (or 0.5 CPD credits) suitable for inclusion in an individual pharmacist’s CPD plan which can be converted to 0.5 hours of Group 2 CPD (or 1.0 CPD credits) upon successful completion of relevant assessment activities.

Clinical Features

Contributing factors

The term COPD is often used as a blanket to cover chronic bronchitis, emphysema, small airways disease and chronic asthma.

The characteristic symptoms of COPD are chronic and progressive dyspnoea, increased sputum production, cough and also other presentations such as chest tightness, wheezing and recurrent bronchial infections2.

The progressive nature of COPD often means that many of these clinical features are overlooked by the patient in the early stages of disease development, sometimes mistaken for general signs of ageing or declining fitness.

Smoking is the primary contributing cause of COPD, with increased rates of smoking causing increases in COPD in higher socio-economic countries3. There is a close relationship between the amount of tobacco smoked and the rate of decline of FEV1,2.

Smoking cessation can slow the rate of lung function decline, delay the onset of disability and preserve remaining lung function2,3.

A key differentiating clinical feature between COPD and asthma is the reversibility of airway obstruction, with COPD being considered a partially reversible airflow obstruction compared to asthma which may be fully reversible after the administration of a bronchodilator.

Spirometry, a lung function test measuring the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled is the gold standard in diagnosis, assessment and monitoring of COPD2. COPD patients have a reduced Forced Expiratory Volume in one second (FEV1) and FEV1/Forced Vital Capacity (FVC) - air that becomes trapped in the lungs and takes longer to exhale in patients with COPD)2.

Whilst smoking is a major risk factor in high and middle income countries, exposure to indoor air pollution from cooking and heating is a contributor to the COPD burden in low-income countries3. Other risk factors recognised for the development of COPD include1,3;

•• Occupational dust and vapour •• Genetic factors (deficiency of alpha 1 antitrypsin (AAT), in approximately 1-3% of the population)

•• Ageing (lung function declines in 3rd and 4th decades of life)

•• Recurrent respiratory tract infections in childhood

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

7

Management Strategies The management of COPD is ultimately aimed at relieving the symptoms of the disease, slowing the progression of lung function decline, preventing (and managing) exacerbations, managing co-morbidities and increasing exercise tolerance and physical capacity.

The Lung Foundation’s COPDX Plan is the Australian and New Zealand management guidelines for COPD. The key recommendations for management summarized in the plan are2:

•• •• •• •• ••

Confirm diagnosis Optimise function Prevent deterioration Develop support Manage eXacerbations

Pharmacological management Pharmacological treatments for COPD consist of bronchodilators and anti-inflammatory agents, with treatments increasing stepwise (unlike the step-down treatment approaches often employed in asthma management).

Bronchodilators: Bronchodilators in COPD aid relieving shortness of breath and exercise capacity. Short-acting agents are typically used as first-line rescue medications while longer acting agents are introduced for COPD which increases in severity. The 3 classes of bronchodilators used in COPD treatment are4,5;

“The characteristic symptoms of COPD are chronic and progressive dyspnoea, increased sputum production, cough and also other presentations such as chest tightness, wheezing and recurrent bronchial infections2.”

•• Beta2 agonists – short acting agents

(SABAs) to relieve symptoms and long acting agents (LABAs) can be used to optimize management. Indacaterol is a LABA indicated for COPD management as a single agent and vilanterol is a LABA available in combination with either inhaled corticosteroids (ICS) or Long Acting Muscurinic Agents (LAMAs)

•• Antimuscurinics – short acting agents (SAMAs) such as ipratropium can be used to relieve symptoms or long acting agents (LAMAs) as maintenance therapy. Tiotropium and newer agents Glycopyronnium, Aclidinium and Umeclidinium are available either alone or in combination products with an ICS or LABA

Corticosteroids: The role of corticosteroids in COPD is less clear than their role in asthma treatment, the type of airway inflammation seen in COPD is different from that of asthma and appears to be more resistant to treatment with both oral and inhaled corticosteroids6.

Oral corticosteroids are used in acute exacerbations, long term use is not recommended. ICS are not used as first line maintenance therapy in COPD and are of limited benefit (particularly in patients who continue to smoke), however they are available in fixed dose combination regimes with LABAs and LAMAs which have been shown to reduce exacerbations and improve lung function4,5.

•• Methylxanthine (Theophylline) – can be added to therapy when in severe COPD when other treatments have failed to manage symptoms adequately.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

9

Training and Education

“Management of the comorbid conditions associated with COPD is important, as patients with severe comorbidities are at an increased risk of acute exacerbations and hospitalizations9.”

Non pharmacological management The key lifestyle intervention for patients with COPD is smoking cessation and evidence suggests that cessation advice from health professionals can help motivate quit attempts and increase quit rates7.

Additional interventions that can be recommended for patients with COPD include2;

•• •• •• •• ••

Referral for pulmonary rehabilitation Increase physical activity Keep up to date with immunisations Support adherence to medications Follow a COPD action plan, after consultation with a GP

Comorbidities associated with COPD

Raising awareness through community pharmacy

There is significant evidence that points towards links between the systemic inflammation of COPD and a number of comorbid conditions, however these are still debated8. However, the following conditions are considered as comorbidities commonly associated with COPD8,9;

In addition to assisting patients in managing their pharmacological therapies for COPD, pharmacists are also well placed to help raise awareness of COPD in the community.

Through running targeted health promotions to raise awareness of the contributing factors for COPD, in particular smoking, community pharmacies can play an important role in helping identify candidates who warrant further investigation for COPD.

•• Cardiovascular disease and diabetes •• Malnutrition (weight loss and anaemia) •• Sarcopenia (age related loss of muscle •• •• •• •• ••

mass) Anxiety and depression Osteoporosis Infections Sleep apnoea Gastro oesophageal reflux disease (GORD)

Management of the comorbid conditions associated with COPD is important, as patients with severe comorbidities are at an increased risk of acute exacerbations and hospitalizations9.

The Lung Foundation Australia’s Lung Health Checklist is a useful screening tool, with all smokers and ex-smokers over 35 years of age considered as ideal screening candidates. Additionally, pharmacists may undertake the use of a PIKO-6 or COPD-6 screening device, which gives an indication of the FEV1/FEV6 ratio – allowing pharmacists to refer at-risk patients to a general practitioner for further spirometry and assessment.

So now is the time, encourage your community to be proactive with their lung health and help your COPD patients breathe easier today!

References 1 Lung Foundation Australia. Making lung health a priority in Australia. COPD: The statistics. 2013 2 The COPD-X Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease V2.39, October 2014.

3 World Health Organization. Fact sheet 315 - Chronic Obstructive Pulmonary Disease [online] 2015 4 Hanania N, Donohue J. Pharmacologic interventions in chronic obstructive pulmonary disease. Proceedings of the American Thoracic Society. 2007;4:p526-34 5 NPS Radar. Pharmacological therapies for COPD in Australia. National Prescribing Service [online] 2014 6 Roche N, Marthan R, Chambellan A et al. Beyond corticosteroids: future prospects in the management of inflammation in COPD. Eur Respir Rev. 2011; 20(121);p 175-82 7 Zwar N, Richmond R, Borland R, et al. Supporting smoking cessation: a guide for health professionals. Melbourne: The Royal Australian College of General Practitioners, 2011.

8 Corsonello A, Incalzi R, Pistelli R et al. Comorbidities of Chronic obstructive pulmonary disease. Curr Opin Pulm Med. 2011; 17(supp) s21-s28 9 Huetes A, Pallange P. COPD: A multifactorial systemic disease. Ther Adv Resp Dis. 2011; 5(3); p217-24 GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

ASSESSMENT QUESTIONS The assessment questions below can be found at the Guild Pharmacy Academy myCPD e-learning platform. Login or register at: www.mycpd.org.au

question 1

question 4

Which of the following statements best describes COPD?

Which of the following best describes the role of corticosteroids in COPD?

a. Progressive symptoms of dyspnoea, increased sputum production and cough starting in early childhood b. A reversible inflammatory airways disease

a. Inhaled corticosteroids should be considered as a first line maintenance option

c. A blanket term often used to cover chronic bronchitis, emphysema, small airways disease and chronic asthma.

b. Oral corticosteroids should be used long-term for maximal effectiveness

d. Progressive decline in lung function primarily due to ageing and declining fitness

c. Inhaled corticosteroids are available in fixed dose combination regimes with SABAs to reduce exacerbations d. Oral corticosteroids are used for acute exacerbations

question 2 Which of the following would be considered the most impactful contributing factor to COPD in middle income countries? a. Indoor air pollution from cooking and heater smoke

question 5 Which of the following comorbid conditions is not recognized as being commonly associated with COPD?

b. Occupational risk factors such as high levels of dust and allergens

a. GORD

c. Recurrent respiratory tract infections during early childhood

b. Osteoarthritis

d. Cigarette smoking

c. Sleep Apnoea d. Anxiety

question 3 Which of the following medications would not be considered as a first line maintenance therapy for COPD? a. Tiotropium b. Glycopyrronnium c. Fluticasone d. Indacaterol

Training and Education

“Now is the time, encourage your community to be proactive with their lung health and help your COPD patients breathe easier today!”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

11

12

Business Profile

VV I L D C H I L D

BY SEAN TUNNY Editor, Gold Cross Products & Services Pty Ltd

The Wild Child group of companies is a 100% Australian owned and operated manufacturer and marketer of medical and personal care products, based in Western Australia. We recently had the opportunity to speak with the CEO of the company, Leanne Preston, and invited her to share a little more about this innovative company.

Editor: Can you tell us a little about Wild Child’s history?

Leanne: Wild Child started when my youngest daughter came home from school with head lice back in 1997. After the initial panic I was further horrified to find that the only solution was to put malathion or permethrin on my child’s skin. I knew enough to know that head lice is more of a social nuisance than

a disease and I couldn’t help but feel that the treatment posed an unnecessary risk to my child. I decided to research alternative ways of combating head lice using natural ingredients and ended up developing Quit Nits, Australia’s first natural head lice product.

Editor: Wild Child prides itself on pure, natural and organic products. Why is this so important to the company?

Leanne: Actually our company has grown to be a turnkey provider of cosmetic and low level therapeutic devices.

Out of necessity and safety, we do manufacture some products which are not entirely natural or organic. Purity and nature underpin our company ethos and we endeavor to provide products that are as close

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

to nature as possible. Aside from the obvious human benefits of natural produce, we are well aware that polymers and synthetic chemicals usually have a much greater carbon footprint than natural alternatives. It takes 230 mJ of energy to make 1L of silicone oil — this is enough energy to propel a car 57 km.

By comparison, a litre of cold pressed vegetable oil takes about 3 mJ to produce.

Editor: People are an integral part of any organisation. What is your approach to this vital resource within the company?

Leanne: I always try to engage staff who are overqualified and under-utilised, this ensures they have the tools to grow their position and a natural tendency to expand their responsibilities. We also foster multitasking so that we are all in touch with the daily challenges our colleagues face. It is very important for workplace harmony that everyone understands why certain decisions are made and how they impact on the company, communication is therefore of paramount importance.

Business Profile

“I decided to research alternative ways of combating head lice using natural ingredients and ended up developing Quit Nits, Australia’s first natural head lice product.”

Editor: Quit Nits and Baby Organics are two primary products in your portfolio. Can you outline why these specific products are such an integral part of the company?

Leanne: Quit Nits was our very first brand and still forms a strong part of the Wild Child lineup, it’s often the number one seller in Australia. If you include the number distributed in the USA and the EU, Quit Nits would sell more than any other Australian brand. Baby Organics was a pet project of mine and it came about after I overheard my pharmacologist husband talking about toxicology and disease latency. It occurred to me that some diseases and conditions of old age may be forged in our formative years. So I set about making a wish list of natural products for infants so that we could delay their exposure to everyday chemicals.

Editor: As CEO, your role at Wild Child is an important and diverse position.

Leader, mentor, decision maker and strategist are just some of the descriptions in a pivotal position such as yours. Could you expand a little further on your role?

Leanne: As an entrepreneur I have always been aware of the principle of Unique Selling Proposition and maintaining an eye for it is

something you have to be constantly aware of. Decisions based on this principle are easy to make, but coming up with a project that is not just another “me too” is harder. Strategy is something that I don’t manage alone; I have an extremely well educated and experienced board of directors at my disposal. I particularly enjoy mentoring young women — I think it’s because there was a serious shortage of good female mentors when I started my business.

recommendations from pharmacists are the primary driver in the success of a product, so we try to meet as many pharmacists as possible at trade fairs and at store level.

Editor: Wild Child distribute through a number of channels, including pharmacy. Can you outline the relationship you enjoy with the profession in more depth please?

Leanne: Wild Child is embarking on an expansion strategy that involves gaining a TGA license to manufacture medicines.

We have already outgrown our Malaga operation and there are plans to build a new facility. We are also expanding our private label, offering to include pharmacy banner groups and larger distributors. There are also some generic drugs in our portfolio which we intend to roll out over the next few years.

Leanne: My very first exposure to sales and marketing was to my local pharmacy in Margaret River. Although a steep learning curve, the insights I gained from retailers who actually interfaced with customers was invaluable. We are well aware that

VV I L D C H I L D

Editor: Wild Child is a manufacturer and marketer of leading edge products.

Within excess of 300 products under your stewardship, what are the future goals and objectives for Wild Child for the remainder of 2015 and into the future?

2 Action Road, Malaga, WA, 6090, Australia P +61 (0) 8 9249 3553 Products available from your local

www.wildchild.com.au

pharmacy or supermarket.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

13

14

Health

Nutritional advice to boost male fertility potential Professor Kelton Tremellen Professor of Reproductive Medicine, Flinders University

While the general public and many health professionals have traditionally considered infertility as a women’s health issue, it has now become clear that impaired sperm quality is actually the underlying reason for failure to conceive in up to half of all infertile couples.1 Furthermore, aside from slowing conception, damage to the sperm DNA has also been linked with an increased risk of miscarriage and potential health issues in the next generation.

Therefore, prospective parents often seek advice from health professionals, such as their pharmacist, on simple lifestyle and nutritional supplements that may assist in improving sperm health and fertility potential.

One of the principal ways in which sperm become damaged, impairing their reproductive function, is through the action of ‘free radicals’. The production of free radicals in the body is increased by smoking, obesity and diseases such as diabetes.1 Normally, sperm are protected from free radical attack by antioxidants such as Vitamin C, Vitamin E and lycopene, all contained within a balanced diet rich in fruit and vegetables.

Furthermore, folic acid and the minerals, zinc and selenium also play a vital role in the production of sperm DNA. However, today’s hectic lifestyle is often characterised by inadequate dietary intake of antioxidants, folate and minerals. This, combined with increasing production of free radicals

due to stresses placed on the body by sub-optimal lifestyle (stress, obesity, smoking and excess alcohol), tips the balance in favour of oxidative stress, resulting in free-radical damage to the sperm membrane (reduced motility and impaired ability to fertilise an egg) and the male DNA. Because of this, several supplements have now been developed with the specific aim of tipping that balance back in favour of protective antioxidants, so as to optimise sperm health.

The Cochrane review on antioxidants in male sub-fertility has concluded that taking an antioxidant supplement can boost a couple’s chances of successfully conceiving during fertility treatment.2 While this Cochrane review compared outcomes using several

“The Cochrane review on antioxidants in male sub-fertility has concluded that taking an antioxidant supplement can boost a couple’s chances of successfully conceiving during fertility treatment.2”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

different antioxidant supplements, only one of these supplements is currently available in Australia in the convenience of a single daily dose formulation.3 When you are next faced with a client enquiring how they may naturally boost their male fertility potential, we would suggest that you advise them to maintain a healthy weight; avoid smoking, excessive alcohol, or heat exposure; boost their consumption of fresh fruit, vegetables and nuts; plus, take a supplement shown to assist sperm health in clinical trials. Importantly, since sperm production takes 70 days, clients should be advised that maximal improvements in sperm function may take up to 3 months.

References 1 Tremellen K. Oxidative stress and male infertility — a clinical perspective. Hum Reprod Update. 2008 May–Jun;14(3):243–58.

2 Showell MG, Mackenzie-Proctor R, Brown J, Yazdani A, Stankiewicz MT, Hart RJ. Antioxidants for male subfertility. Cochrane Database Syst Rev. 2014;12:CD007411.

3 Tremellen K, Miari G, Froiland D, Thompson J. A randomised control trial examining the effect of an antioxidant (Menevit) on pregnancy outcome during IVF-ICSI treatment. Aust N Z J Obstet Gynaecol. 2007 Jun;47(3):216–21.

Quitnits NATURALLY At Quitnits we discovered that some of the most effective remedies are found in nature.

Our scientists have spent years studying mother nature and unlocking her secrets in pursuit of developing products that have the potency to kill head lice efficiently and effectively, whilst being kind and gentle on our children and the environment.

To check out our full range please visit our website:

www.wildchild.com.au Proudly Australian owned and operated.

DEFENCE AGAINST HEAD LICE

TREAT

COMB

DEFEND

Oral pain? It’s covered.

Introducing MucoLox™, a revolution in mucosal adhesion, exclusively from PCCA. MucoLox is an innovative base that can be used alone or with active pharmaceutical ingredients (APIs) – and it’s revolutionizing how compounding pharmacists help treat oral pain for dental, orthodontic and cancer patients. Here’s how: • Super-adhesive for long-lasting coverage • Increased contact time for gradual and continued release when compounded with APIs

MucoLox™ compounded with APIs

Bonding polymers create better adhesion and increased contact time delivers more APIs to affected areas

PCCA member? Contact Customer Service at 02.9316.1500 for samples.

Not a member? Contact us at 02.9316.1500 or email info@pccarx.com.au

Mucus membrane

02.9316.1500 l pccarx.com.au

Mouth ulcer

18

Health

“Access to innovative bases such as PCCA Mucolox™ allows compounding pharmacists to optimise treatment of conditions of the oral mucosa, overall improving compliance and positive outcomes for patients”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

Health

Introducing PCCA Mucolox™ A mucosal delivery system that’s got oral pain covered

by Marina Holt BPharm MPS MACP

>> www.pccarx.com.au

PCCA Mucolox™ is a water soluble mucosal delivery system that can be used alone or with various active pharmaceutical ingredients.

Delivery of medication via the oral mucosa has been continuously evolving since the mid-1980s due to the development of novel delivery systems which allow for increased efficacy upon delivery. Since then, the oral mucosa has been an ideal target for drug delivery due to the ability of the medication to bypass first-pass metabolism, avoid gastrointestinal degradation, and achieve more rapid onset of action. Within the oral mucosa lies the buccal mucosa, which is comprised of non-keratinised epithelial cells that line the inner cheeks.

that adheres to the mucosal lining of the cheeks and prolongs contact time.

The optimal mucoadhesive properties exhibited by PCCA Mucolox™, which have been assessed against a commercial reference product, are ideal features sought after by many compounding pharmacists searching for bases to be used in the treatment of diseases and conditions of the oral mucosa.

Buccal delivery is advantageous in that the buccal mucosa is highly vascularised, has low levels of enzymatic activity and is fairly immobile, making it a suitable site for both local and systemic delivery of medication.

However, one of the greatest disadvantages of buccal delivery is the low residence time (time at site of action) of the medication, which can be due to various factors such as continuous section of saliva triggering involuntary swallowing, intake of food and movement of the tongue.

These conditions include, but are not limited to, mucositis (ulceration and inflammation of the mucous members), candidiasis (fungal infection), recurrent ulcers, bacterial infections, trauma of the oral mucosa and dry mouth syndromes.

For example, at least forty percent of patients who undergo chemotherapy and eighty percent of patients who undergo radiotherapy for the head and neck will suffer from the ulceration and inflammation of the mucous membranes caused by these treatments.

This will result in pain and discomfort, and may impact on the patient’s ability to eat.

If not controlled, mucositis may ultimately impact on the completion of treatment.

All of these factors can influence the efficacy of medication designed to be delivered via the buccal mucosa. Recognition of this drawback has led to the development of mucoadhesive polymers, a delivery system

For this reason, compounding pharmacists are concerned that the medication prepared will not add additional burden to the patient’s medication regime. It is therefore beneficial to use a base with high mucoadhesive strength

and long mucosal retention to prolong the contact between the medication and the site of action. This reduces the need for frequent dosing because the effectiveness of each dose is optimised. Any active ingredients which have been incorporated into the preparation are not washed away with the base by saliva and can remain at the affected site.

The network of polymers in PCCA Mucolox™ provides a unique bond to the mucosa creating long-lasting moisturisation and coating effects, which means it may be used on its own, without adding any active ingredients. The product is free of gluten, casein, dye and parabens and has a low glycaemic index which is suitable for diabetics or patients requiring a restricted sugar intake.

Compounding pharmacists are in a unique position to be able to address an individual patients’ needs and prepare a customised medication for them.

Access to innovative bases such as PCCA Mucolox™ allows compounding pharmacists to optimise treatment of conditions of the oral mucosa, overall improving compliance and positive outcomes for patients who are already in pain and discomfort from their underlying conditions.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

19

20

Business

Partnerships – The Three Gs! Peter Saccasan FACP FCA CTA Director of Pharmacy Services, RSM Bird Cameron Chartered Accountants peter.saccasan@rsmi.com.au

That’s right ... getting in, getting along and getting out. Going into business with colleagues has a certain appeal to it — sharing the load in many respects. You can share the financial burden, the business stress, management duties and even have alternate holidays so that the business runs smoothly. Many good points to admire, I am sure. But when times get tough, who can do what, when, and to whom, becomes important.

g

in, g n i t t e ng o l a t. g u n i o t t e g n i t et and

g

g

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

BUSINESS

“There are a number of areas to consider before Getting In. If you can agree on these key areas, Getting Along will be easier and Getting Out will be managed and controlled.”

Key areas to consider There are a number of areas to consider before Getting In. If you can agree on these key areas, Getting Along will be easier and Getting Out will be managed and controlled.

These include:

•• •• •• •• •• •• •• ••

Getting it right at the start — make it a priority Many partnerships start off almost accidentally. Usually someone starts looking at a pharmacy, gets some way down the track in the investigation and then decides a partner would be a good idea. Someone they know sort of says ‘Yes’ and, whilst there is a lot of flurry about buying the pharmacy (because it’s all urgent at this point), the partnership agreement becomes one of those things we will get around to later — and, of course, they never do.

This is a recipe for disaster, especially if you are a partner buying an interest in the partnership of less than 50%.

The first step is for someone to make this a priority. If one of the partners starts to make it clear that no bank borrowings will be signed up until this is sorted, then I can imagine you would have everyone’s attention. If you are dealing with a law firm (of any size), it would be quite possible to have one person in the firm working on the purchase transaction, whilst another is sorting out the partnership agreement.

share of equity income between partners salaries for working in the business income protection insurance to be held by each partner life insurance (in case someone falls under a bus) using the pharmacy as security for bank borrowings each partner’s role exit provisions.

And that is just to name a few. There are further complications to be sorted, for example in the event where two pharmacies are merging, valuations, cut-off issues, timing due to pharmacy regulations and sorting out existing liabilities will need to be considered.

It would pay to get together with someone who can facilitate these discussions, so that you can write down the outcomes and put them into a concise brief for your solicitor, who will ultimately draw up the partnership agreement. Simply going to your solicitor empty-handed without some direction might prove to be costly.

Getting Out need not be painful Partnership dissolutions can be very painful.

Without an agreement which sets out very precisely how this is to work, it can be a torturous path. What is almost as bad, is having an agreement which is deficient in many areas when dealing with the dissolution of the partnership. In my experience, the achievement of an agreement that addresses the issues sensibly and with completeness, requires the input of an accountant as well as a lawyer. There are a couple of stand-out areas here too:

•• You need to deal with multiple entities (e.g. a service entity) to ensure all equity and liabilities are covered.

•• Timing is generally the biggest issue given the regulation that surrounds change of ownership of pharmacy. Think about it — you need a solution that deals with the fact that you have responsibilities until the pharmacy board approves the change of ownership. You would like to get paid once this happens, but in order to do this, the partner who is doing the buying needs to talk to banks and get your co-operation to sign things and agree on amounts — all, well before the pharmacy board date. At the same time, generally the partner staying doesn’t want you around, but you still carry responsibility. And, if you are in partnership until the board date, you can’t work out the final number until that date has passed.

•• And you can throw in to the mix, in NSW for example, there are some stamp duty exemptions for incorporation of pharmacies. Such a move may be part of a change in partnership, but needs careful understanding and implementation.

Sound difficult? It is. We have had experience in setting out an agreement that will address these issues. But perhaps the worst situation is when partners go forward blindly and make an agreement between them on what the exit price and terms are and when they come to their accountant, it is found that one party has been greatly disadvantaged. At this point it can be very difficult to change the other person’s mind about how much they are going to get.

Get it right from the beginning When you think about it, usually at the start of the partnership most partners are in a more agreeable mood and it is easier to get compromise, which is better than paying expensive fees to lawyers and accountants to sort out the mess at the other end. So be wary and be sure to get the right advice before you make that ‘lifelong commitment’ of going into partnership.

21

Leases Under Control?

A subscription to MiLease provides the strategic lease management you need to take back control!

Document bank for e-storage of lease Email notifications of critical diary dates Audit of lease and rental payments Monthly sales review Quarterly benchmarking and occupancy review Lease critical path management and reporting CPI reports Industry Newsletters Duplicate addressees for critical lease notices Day to day operational support Customised reporting and more - for only $60 per month

Join the MiLease Program to outsource your very own specialist retail property team.

“Its like an insurance policy for your lease” 1300 766 369 | info@milease.com.au | www.milease.com.au

“Retailers don’t get what they deserve they get what they negotiate...”

Before you sign any lease, or if you have an issue with your Landlord, call Lease1. Initial advice is free to PGA members.

1300 766 369 | pharmacy@lease1.com.au | www.lease1.com.au

RSM health+ RSM health+ Pharmacy Pharmacy

Fit-out management Fit-out management

Accounting and tax Accounting and tax

Buying a pharmacy Buying a pharmacy

Going into partnership Going into partnership

Experience Experience and Knowledge and Knowledge

Business broker

Fit-out management

Accounting and tax

Buying a pharmacy

Choose RSM Bird Cameron.

Experience the benefits.

Better pharmacy plan

Marketing Marketing

Risk management Risk management

Business improvements Business improvements

Financial planning

Going into partnership Specialist bankers Specialist bankers

Your Your pharmacy pharmacy business business

Better pharmacy Betterplan pharmacy plan Retail improvement

Experience and Knowledge

Lawyers Lawyers

Access to Access to pharmacy specialists pharmacy specialists

Your pharmacy business

SME cloud solutions Retail improvement Retail improvement

Access to pharmacy specialists

Valuation specialists Financial planning Financial planning

Lawyers

Structuring your business

Business improvements

Risk management

Marketing

Business broker Business broker

Specialist bankers

Your strategic partner in pharmacy

Choose Choose RSM RSM Bird Bird Cameron.

Cameron.

Experience Experience the the benefits. benefits.

SME cloud solutions SME cloud solutions

Valuation specialists Valuation specialists

Structuring your business Structuring your business

Your strategic partner in pharmacy Your strategic partner in pharmacy

Pharmacy

RSM health+

24

Business

Beware market rent review traps

BY Phillip A. Chapman Phillip A. Chapman is the Founder of Lease1 and Director of MiLease Strategic Lease Management, both of which are endorsed Gold Cross Member Services.

Lease rental structures have changed over the last decade with mid-term market rental reviews, at three or five-year intervals, less prevalent. Annual rent increases now tend to be fixed percentages, CPI or a combination. But virtually all leases with option periods are likely to include market rental review clauses. While these clauses are fairly standard, as with most aspects of lease agreements, the devil is in the detail.

BEWARE THE TRAPS Traps in the rent review process can catch out unsuspecting tenants and cause major problems if not fully understood. The traps that landlords use to their advantage are varied.

Many leases are structured to provide landlords with the scope to issue review notices during a longish ‘window of opportunity’, either before or after the actual rent review date. This allows landlords to assess market changes and only issue notices that will likely support a positive rental outcome.

In response, tenants often have short time frames to respond, generally in as short as 21 days. Usually, a non-response within the allocated time results in automatic acceptance of the proposed new rental by default. Taking advantage of this, landlords have a habit of issuing rent

notices immediately prior to holiday periods or will send rent notices to old or different addresses from usual correspondence. A rent level determined by default is once again likely.

Other landlord tactics include proposing excessively high rents, knowing further negotiations will eventuate. This may ignore ‘cap and collar’ provisions to ensure rents do not rise or fall beyond a specified range, knowing that many tenants do not fully understand the implications. The outcome is likely to depend on which party can hold out for the most advantageous position.

In a relatively ‘flat’ market, a landlord rent notice may indicate a relatively small (4–5%) rental increase with the hope the tenant will be too busy to become involved in a rental dispute.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

FACE OR EFFECTIVE MARKET RENTS One of the most important aspects of the rent review clause, often misunderstood, concerns rental being ‘face’ or ‘effective.’

•• Face rent is the rental payable as set out in the lease agreement before taking into account incentives or increases.

•• Effective rent is this rental amount the landlord receives after paying all expenses for operating the property, and any costs for tenant work and amortising incentives.

Because the incentive is usually calculated on the aggregated rental payable over the initial period of the lease, mid-term market reviews should be based on comparable ‘face’ rentals. However, reviews at the end of the initial term when an option to renew is being considered, should arguably be based on comparable ‘effective’ rentals.

Business

MARKET REVIEW PROCESS In the rent review process the landlord usually provides a new rent notice based on an assessment of market dynamics, and the lessee then has the opportunity to disagree or agree within a given time frame.

•• If the lessee agrees, then no further

••

••

•• ••

action is required and the new rent is established.

If the lessee disagrees, the landlord should be notified within the required time frame, possibly proposing an alternative rental.

If the landlord agrees, no further action is required and the new rent has been established.

If there is no agreement then a ‘determining valuer’ is appointed.

The parties usually make submissions to this valuer, who will also consider market evidence and make market rental determination. This decision is usually final.

OPTION PERIOD REVIEWS There are often issues in the rent review process when the option is exercised.

Most lease agreements are structured once the rental has been determined. Therefore, the tenant does not know the new rental prior

“The time to ensure the rent review clause meets your needs is before a deal is committed.”

BE PREPARED

Any rent notice received should immediately be dispatched to the responsible party. If possible, prepare for rent notices before they are issued. Ideally, the focus of the rent reviews should be to agree to the new rent before the formal review process.

When finalising a new lease agreement, focus on the detail in the clause and reference the relevant legislation. The time to ensure the rent review clause meets your needs is before a deal is committed. Once the lease agreement is finalised, the focus should move to internal lease management. A critical lease data system, providing timely renewal and rent review dates, is fundamental to effective portfolio management.

Understand the terms, requirements and possible interpretations of the rent review clause. Most importantly, be prepared to play the landlord’s games. Make sure the landlord’s rent notice has been issued in accordance with the lease requirements. Whatever rent notice arrives, be sure to review, analyse and object even if it is only 3%. Landlords rely on tenants being overcome by inertia and avoiding confrontation.

to making a decision to stay. This is acceptable if the tenant prefers not to relocate.

But it is important to know what the fall-back rental is in the current premises.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

25

26

Health

Breaking Down the Misconceptions of Incontinence

Pharmacists urged to help Australians better understand light bladder leakage and incontinence

BY SEAN TUNNY Editor, Gold Cross Products & Services Pty Ltd

With more than half of the Australian population currently experiencing — or having previously experienced — urine leakage, pharmacists are being reminded to consider the psychological, as well as physical impact of incontinence during consultations with customers.

A recent study conducted by Kimberly-Clark revealed that 40 per cent of those who suffer from urine leakage decide to ignore the symptoms and do nothing about it.

The study also highlighted the common misconception that urine leakage is a condition of the elderly, revealing one in three 18 to 24 year olds and 38 per cent of 25 to 34 year olds suffer from the condition.

Sydney incontinence expert, Joanne Lawrence, said there are a range of other age agnostic factors that also contribute to incontinence, including stress, depression and anxiety. This is particularly high for men, with 14% citing the most common time they experience urine leakage is as a result of being stressed, depressed or anxious.1 Lawrence continued on to say that childbirth is the greatest cause of incontinence after old age, affecting just under one in three women (31%)2. Pregnancy also causes urine leakage for 19 per cent of women,3 while one in ten men (11%) who have prostate problems have also reported that they have suffered the condition.4 “What’s equally concerning is that one in three Australians who have suffered from

urine leakage are resigned to feeling there is no solution to their bladder problems,5 and they just have to live with it. There is a need for pharmacists to be aware of the common causes and psychological impacts, ensuring they’re providing suitable advice to patients of all ages and walks of life,” Lawrence reinforced.

“Many patients suffering with bladder leakage are looking for solutions.

Advice and understanding from a pharmacist in a confidential environment, to help identify ways to manage the condition, is the first step towards effective management,” said Lawrence.

“There is a need for pharmacists to be aware of the common causes and psychological impacts, ensuring they’re providing suitable advice to patients of all ages and walks of life.”

Light bladder leakage and incontinence is an uncomfortable condition, impacting the confidence and social life of many Australian sufferers on a daily basis.

A spokesperson for Kimberly-Clark advised that they have developed Depend® Real-Fit Underwear for men and women with incontinence and discreet liners POISE for those suffering from light bladder leakage.

Tailored for different levels of urine leakage, the range provides comfort and protection for sufferers as they work towards solutions to better manage their condition.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

References 1 Lonergan Research, Incontinence Investigation, June 2013, p. 9 2 Lonergan Research, Incontinence Investigation, June 2013, p. 9 3 Lonergan Research, Incontinence Investigation, June 2013, p. 9 4 Lonergan Research, Incontinence Investigation, June 2013, p. 9 5 Lonergan Research, Incontinence Investigation, June 2013, p. 11

Developed by Dermatologists

Salicylic acid

Hair

Coal tar & Coconut Oil

Scalp

28

Health

Be a health destination

and put your pharmacy on the map Jane Larter B.Pharm Pharmacist – Trainer and Assessor; Pharmacy Guild of Australia QLD

Australians are travelling overseas in ever-increasing numbers. At any time of year we have customers visiting our pharmacies asking for advice on what they need to do or take before travelling overseas, whether it’s in regards to work, or just for a destination holiday.

There are many ways in which we can help our customers make sure they have a safe, enjoyable and memorable journey.

What everyone needs to be aware of before they travel overseas is that once you leave Australia you are leaving behind Australia’s support systems, emergency service capabilities and medical facilities. For healthy travel, there are many things that should be considered and many of these we can assist our customers with.

Check-up before departure Every year Australian travellers become ill, or even die, while travelling overseas.

It is very important that our customers make an appointment with their doctor for a basic health check-up at least 6–8 weeks before they depart for their overseas adventure. It’s easy to forget when travelling overseas that not everywhere is the same as Australia when it comes to diseases, and that prevention is much better than a cure. Infectious diseases are often preventable through vaccinations, which may require one or more doses before departure.

Customers may need to ensure that they have the correct vaccinations for their place of travel and that any booster doses of childhood vaccinations are up-to-date.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

Health

“It’s easy to forget when travelling overseas that not everywhere is the same as Australia when it comes to diseases, and that prevention is much better than a cure.”

It is also recommended that a customer discuss with their doctor any medication they will need to take, along with relevant health issues associated with the holiday, such as altitude sickness. The best course of action when medication is required is to carry a letter from their doctor detailing what the medication is, how much they will be taking with them, and stating that the medication is for their own personal use — leaving the medication in its original packaging so it’s clearly labelled with their name and dosage instructions.

The best way to know if a medication is legal in the countries a person is visiting is to contact the relevant embassy or consulate in Australia.

Customers should also be made aware that it’s an offence to carry or send PBS medication overseas, unless it’s for their own personal use, and fines will apply if they break the law.

What to pack From travellers’ diarrhoea through to serious infectious diseases such as rabies, malaria or hepatitis A, the people who seek pre-travel advice are better placed to avoid illness and look after their health while away. Assist your customers to prepare a first aid/medical kit for the trip — and if time permits, recommend they consider doing a First Aid Course.

Customers should also consider getting (and wearing!) an alert bracelet or necklace if they have a serious health condition or allergy.

After offering our assistance with a customer’s medical needs when travelling overseas, we can remind them to have a look at www.smartraveller.gov.au for further information.

Be prepared — get insurance Something my parents taught me was if you can’t afford travel insurance, you can’t afford to travel. Insurance is therefore something I always consider as part of my travel budget — but it’s something that is often missed by many. What people forget is that overseas medical costs are not covered by Medicare,

and that the costs can become rather expensive if you become unwell. Discuss the importance of travel insurance with your customers and ask if they have considered it for their upcoming holiday.

Additional health tips •• If the trip will involve an increase to one’s usual physical activity, such as a lot of walking, gradually build up fitness over the weeks, or preferably months, before departure.

•• Factor the effects of jet lag into the itinerary.

•• If scuba diving, don’t travel in an aircraft for at least 24 hours after the final dive.

•• To help avoid deep vein thrombosis: drink plenty of fluids (avoiding alcohol and caffeine), stretch feet and lower legs while seated, and walk around the aeroplane cabin at regular intervals.

•• Where local tap water is not safe: only use bottled water to drink and brush teeth and always check the seal, don’t put ice in drinks and avoid uncooked food, including salads and fruit.

•• Check the latest travel advice and travel bulletins for the destination before departure and while travelling so customers can ensure they have the latest information.

Useful information resources and websites Australian Department of Foreign Affairs and Trade – www.smarttraveller.gov.au World Health Organisation, International Travel and Health – http://www.who.int/ith/en/ NPS MedicineWise Medicines, Information Line – www.nps.org.au (1300 633 424)

Contents of a basic medical kit First-aid items: adhesive tape antiseptic wound cleanser or alkaline soap

bandages scissors safety pins emollient (lubricant) eye drops insect repellent insect bite treatment antihistamine tablets nasal decongestant oral rehydration salts simple analgesic (e.g. paracetamol) sterile dressing clinical thermometer sunscreen earplugs tweezers adhesive strips to close small wounds

Additional items according to destination and individual needs: medication for pre-existing medical

conditions along with sterile syringes and needles antidiarrhoeal medication antibacterial ointment antifungal cream antimalarial medication and mosquito net and insecticide to treat fabrics (if applicable) adequate supplies of condoms and oral contraceptives spare eyeglasses and/or spare contact lenses (and solution) other items to meet foreseeable needs, according to the destination and duration of the visit

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

29

d 30 0

ps ro

10ml

can be used months after opening preservative-free phosphate-free compatible with all contact lenses

STAY ON TOP OF REFLUX

ACID POCKET: An emerging therapeutic target for reflux disease

THE ONLY REFLUX THERAPY PROVEN TO ELIMINATE THE ACID POCKET 1,2,3,4

The acid pocket is a key contributor to reflux and is defined as a layer that sits on top of the stomach contents closer to the esophageal junction and is highly acidic5,6.

Acid suppression therapy reduces the size and acidity of the acid pocket, but does not eliminate it completely1,2 nor alter reflux frequency.2,7 Gaviscon Dual Action Liquid directly targets the acid pocket by both rapidly creating a raft that displaces the acid pocket9,10 and neutralizing acid pocket contents thus effectively suppressing reflux8,10, providing longer-lasting relief than traditional antacids (e.g. Mylanta), which sink quickly to the distal stomach.9

References: 1. Vo L, Simonian HP, et al. Aliment Pharmacol Ther. 2005;21(11):1321–1330. 2. Rohof 2014, Clinical Gastroenterology and Hepatology 2014;12:1101–1107 3. Strugala V, Avis J, et al. J Pharm Pharmacol. 2009;61(8):1021–1028 4. Wang Y-K et al. Gastroenterology Research and Practice 2013; 2013 Article983653. 5. Beaumont H, Bennink RJ, et al. Gut. 2010;59(4):441–451. 6. Clarke AT, Wirz AA, et al. Gut. 2009;58(7):904–909. 7. Hemmink GJ, Bredenoord AJ, et al. Am J Gastroenterol. 2008;103(10):2446–2453. 8. Kwiatek MA, Roman S, et al. Aliment Pharmacol Ther. 2011;34(1):59– 66. 9. Sweis R, Kaufman E, et al. Aliment Pharmacol Ther. 2013;37(11):1093–102. 10. Rohof W, Bennink R, et al. Clin Gastroenterol Hepatol. 2013. pii: S1542–3565(13)00621–6. doi: 10.1016/j. cgh.2013.04.046. Always read the label. Use only as directed. If symptoms persist see your healthcare professional. ® Gaviscon is a registered trademark of RB Australia. 44 Wharf Road, West Ryde, NSW 2114.

32

business

Success in Sport, Business and Life!

BY SEAN TUNNY Editor, Gold Cross Products & Services Pty Ltd

Scott Draper is a former Australian World Top 50 ranked professional tennis player who transitioned as a professional golfer. He has won the Australian Open Mixed Doubles with Sam Stosur, reached the fourth round of two consecutive French Opens, and the fourth round of the US Open. He has played Davis Cup for Australia and held match points against Roger Federer.

“As performance challenges are ubiquitous, I continually look where I can take what I’ve learned and apply that to help people in any domain, whether it be in sport, life or business.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

business

“High performance is about consistency.

One of my favourite sayings is — perfection isn’t attainable, but if you chase perfection, you might catch excellence.”

Scott reached a career high world ranking of 42. He has transitioned from sport into business in a senior position as developmental tennis manager at Tennis Australia.

More recently, Scott began working with business as a performance and change consultant. I had the opportunity to meet with Scott, without a tennis racquet or golf club to be seen, to uncover a little more about his successful background in sport and business, and a little about life in general.

Editor: Thanks for the opportunity to meet, Scott. Can you share with our readers a little about yourself?

Scott: I am the youngest of three and come from a family of sports and music fanatics.

I loved my sport and knew pretty early on that I wanted to be a tennis player. In my late teens I battled with OCD and later travelled the world with my late wife, Kelly Greig. During that time, I fell in love with golf and at the end of my tennis career, I decided to go play professional golf, which was awesome — I spent 5 years doing that. Then out of golf, I went back to Tennis Australia and have become a real family man — father of three, with my beautiful wife, Jessica. Overall, I’m really passionate about life, performance and having a crack.

Editor: A professional sportsman, achieving in not one, but two difficult sports must be almost unheard of.

Can you please outline a little of your journey as a professional in your chosen sports?

Scott: I was just playing tennis and following my mum, dad, brother and sister, and used to go to all the local tournaments and loved it. It wasn’t until I left school that I thought it was time to get serious and make a living. There’s a lot of pressure and I think I battled that for quite some time, but I was lucky enough to meet Michael Fox. He is a psychologist who helped me reshape the way I competed — I would get frustrated and take low percentage options, but he really helped me reframe the way I went about my game. I had an incredibly fast rise at that stage and, when I was 21, I went from no ranking to top 100 in 9 months. That set the scene for a lot of my adult life, as I always try to be the best competitor I can be. I was introspective

about how I could continuously improve and learn from what I was doing, and learn from my mistakes.

Editor: After enjoying a professional sporting career at a high level, you made an equally high transition into business.

Did you choose this path or did it choose you?

Scott: I think probably a combination of both, and an interesting part of that question is about choice. I think we all go through stages of our life wondering what that road looks like and what the right path is. Where am I going to be successful? I think that I’ve always loved sport because it has so many great characterbuilding attributes. It’s an opportunity to always challenge yourself and, because in sport you get so many opportunities to compete, whether you win or lose, there is so much feedback in that experience. As performance challenges are ubiquitous, I continually look where I can take what I’ve learned and apply that to help people in any domain, whether it be in sport, life or business.

Editor: Pharmacy is one of the most highly respected, ethical and trusted professions in the world. What defines ethics and integrity for you in business, sport and life?

Scott: That’s a really good question.

I think of ethics as something as simple as — do unto those that you would have them do unto you. You want to treat people as you want to be treated yourself. I have always said that integrity has no reflection; people sometimes do things because they want to look good, or it’s the right thing to do in a social setting, but it’s what’s inside.

It’s about who’s doing the right thing when no one is watching. To me, that is a good ethical yardstick. This, what-you-do-when-noone-is-watching philosophy, reminds me of the attributes of successful people. Internal drive enables you to do the work required to excel in the absence of any external help, and the most successful people are those that train hard when no one is watching.

Editor: Australian Community Pharmacists are medication experts

who provide a service that supports a model of health and wellbeing for all Australians. In your current role, in brief, how would you support a pharmacy who wanted to work on change and business performance?

Scott: First of all, change is personal.

Coming from my coaching background, I’ve found it very hard to coach anyone who doesn’t want to be helped; people have got to be a hundred percent committed to that change. You need to work together to build a plan based on information you have and sometimes we don’t delve hard enough to find out what that is. The second thing is, where are we now? You have to understand the direction you need to take. What is your vision?

What is the purpose of the organisation?

And, what is the ultimate reason for being?

If you can answer those questions, you can really start working at what values and behaviours are going to take you there.

Figure out the strategy and other priorities that are going to help get you there, and then ask — what’s the action plan?

Editor: Could you define a highperformance team culture?

Scott: For me, high-performance culture is a team that is really dedicated to achieving whatever it is that they set out to achieve, while standing shoulder to shoulder. No matter how good an individual, if that individual is in a great environment where everyone is holding each other accountable, then that individual will be even better. If you want a highperformance culture, it takes a lot of work; it’s ongoing, constant reinforcement, and you have to set the process — set the standard.

You can’t just expect that it’s going to happen; you really have to spend time working from the foundation of what it needs to look like all the way up, and continually reinforce those things you’ve tried to implement.

Editor: Is a low- or poor-performing culture the direct polar opposite in comparison?

Scott: High performance is about consistency. One of my favourite sayings is — perfection isn’t attainable, but if you chase perfection, you might catch excellence.

I think that if you have a team that’s always striving to be that, then you are on the right road.

In our next edition, we will discuss with Scott three (3) vital steps to building a team and high-performance culture in a Pharmacy environment.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

33

34

Guild Pharmacy Academy update!

News

Revive Your Pharmacist Only Medicines Section

Log on to the myCPD site to access this course and many other CPD accredited courses at www.guild.org.au/academy

There has been much written about the Pharmacist Only Medicines section and the demise of this schedule in community pharmacy. For a multitude of reasons this important section of our pharmacies has been labelled a ‘grave yard’ or ‘dead’ by many in the industry. Whilst much has been written very few have been able to offer solutions.

consider the physical environment where Pharmacist Only Medicines are located. Is the area well organised? Is there adequate space to speak privately with a customer? And does it have the necessary resources a pharmacist would require to counsel a patient?

The second half of the course assists the user in implementing the changes that need The online course, ‘Pharmacist Only to be made in the pharmacy to make the Health Solutions – Preparing Your Pharmacy Pharmacist Only Medicine section an integral for Change’, which is available for Guild part of the pharmacy offer. This section members and employee pharmacists who guides the pharmacist through the change work in Guild member pharmacies provides Thanks toprocess andfrom includes the key steps in change Linda and Jenny Werrington Pharmacy NSW for a practical guide to assist in reinvigorating participating management. in the photographyFirstly, the user is asked to plan the Pharmacist Only Medicines section the changes they want to make by setting of your pharmacy. goals and identifying success measures.

The course includes an action plan that can Many of the online courses available be downloaded to assist the pharmacist on the myCPD site offer pharmacists an in achieving this. update in a key health condition or medicine

GUILD INTERN TRAINING

that increases their knowledge. This course is significantly different. Users who complete this course need to approach it with the Guild interns make the best interns because they have access that to: it is not a knowledgeunderstanding based course, but one that requires the user • A program balanced with clinical and business knowledge to complete sections of the course and then • Comprehensive exam preparation go away and work on a change management • Visits from a clinical tutor providing on-site assistance mentoring process in and the pharmacy.

• Training in the latest professional programs and Firstly, services under therequires the user this course 5th Community Pharmacy Agreement

to assess their Pharmacist Only Medicines section analysing the current situation, To find out more visit our website or call your local by Guild branch. identifying the gaps and identifying the ideal situation. The course provides the user with a range of assessment tools that they can www.guild.org.au/academy use to observe what is currently occurring in the pharmacy when a customer requests NSW & ACT - 02 9467 7124 / QLD - 07 3831 3788 / TAS - 03 6220 2955 / WA - 08 9429 4100 a Pharmacist Only Medicine.

The observation tool asks the user to identify how and when pharmacy staff refer, or in some cases don’t refer, customers to the pharmacist. It asks the user to evaluate the pharmacists’ accessibility to customers when they request a medicine or are referred by a staff member. And it asks the user to GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

Also included in this course are a range of downloadable tools that will be of value to the pharmacy. These tools include a customer referral slip, a list of non-pharmacist tasks that could be delegated to pharmacy staff, links to health promotion organisations and a list of Pharmacist Only Medicines.

There are many courses available on the myCPD site which will assist you in gaining your required CPD points before the end of September. But if you want to gain those points, as well as implement a change to grow your business, then consider completing this course.

There is no doubt that undertaking the change management process to reinvigorate your Pharmacist Only Medicine section is a significant change for everyone in the pharmacy, including the customers.

But by using this practical course and the range of tools, tips and advice, the pharmacist can plan their approach, develop an action plan and implement the changes in a deliberate and organised manner.

Supporting male fertility before the journey begins

■ Specifically ■ Menevit

formulated to support sperm health

has demonstrated to significantly help

ü Improve pregnancy rates ü Improve sperm quality

For more information on Menevit visit www.menevit.com.au or free call 1800 023 884.

Menevit contains Folic Acid, Zinc, Vitamin C and Vitamin E. For full list of active ingredients, see the label.

1. Tremellen K et al. Aust NZ Obstet Gynaecol 2007; 47:216-21. 2. Tunc O et al. Repromed Biomed Online 2009; 18(6):761-8

2

1

DISCREET, COMFORTABLE PROTECTION NEW

VERY LIGHT TO MODERATE PROTECTION POISE® Active Microliners & Ultrathins • Thin, flexible, drier^ and more absorbent to keep user feeling fresh during exercise • Drawstring pack and individually wrapped for on the go lifestyle ^ Drier than feminine care products when re-wet is compared against leading feminine care products

Your customers get their 6th POISE® or DEPEND® product free* when they buy 5 * Conditions apply

Looks, fits and feels like real underwear, with superior absorbency

MAXIMUM PROTECTION • Gender specific design • Absorbent core zone especially for women and men • Worry free odour protection

www.poise.com.au

www.depend.com.au

® Registered Trademark Kimberly-Clark Worldwide, Inc. © KCWW. Image of models, for illustrative purposes only.

Don’t let

your eyes ruin your day

Murine® is driving customers into your pharmacy with high-impact advertising support AUG TV

SEP

OCT

NOV

DEC

●

●●

●

●

Radio

●

●

●

●

Outdoor

●

●

●

●

Print

●

●

●

●

●

Digital

●

●

●

●

●

Instore

●

●

●●

●

●

● Murine® Eye Mist

● Murine® Clear Eyes

www.murine.com.au

Always read the label. Use only as directed. If symptoms persist, see your healthcare professional. ® Registered trademark of Care Pharmaceuticals Pty Ltd. ABN 30 009 200 604.

38

Training and Education

COPD, Asthma and Inhaler Technique

BY ROMA CECERE General Manager – Strategic Business Performance, GuildCare

Chronic Obstructive Pulmonary Disease (COPD) describes several long-term lung conditions, that gradually worsen and cause shortness of breath, by reducing the normal flow of air through the airways. These conditions include emphysema and chronic asthma.

The World Health Organisation (WHO) says the primary cause of COPD is tobacco smoke.

It now affects men and women almost equally, partly due to increased tobacco use among women in high-income countries. However, almost 90% of COPD deaths occur in low and middle-income countries.1 Whilst COPD is incurable, treatment can slow its progress.2

It affects people of all ages, with death rates in Australia high by world standards, peaking in late winter for those aged 64 and over.

The WHO estimates 235 million people are asthma sufferers, citing it as ‘one of the (world’s) major non-communicable diseases.’3

Inhaler technique data recorded in GuildCare also shows a spike in cases recorded in wintertime.8

COPD IMPACTS QUALITY OF LIFE

PUFFING PROPERLY MAY PREVENT DEATHS

In Australia, up to 20% of people over forty are believed to be affected by COPD. It is the fourth most common cause of death in men, and the sixth most common in women, mainly affecting older people. It’s a leading cause of death, both in Australia4 and internationally,5 with death rates highest in winter.

In a recent global study published in the Lancet, Australian co-author Professor Louisa Degenhardt, (UNSW National Drug and Alcohol Research Centre) says deadly diseases like COPD cost “Australians many years of healthy life”.6 Ten per cent, or over two million Australians have asthma, one of the highest rates globally. In winter, respiratory tract infections typically increase and the common cold is behind 80% of asthma flare-ups or attacks.7

Dr Kerry Hancock, Chair of General Practitioners’ Asthma Group, National Asthma Council, says during winter, “respiratory viruses such as colds and influenza can worsen asthma”.

The Australian Institute of Health and Welfare (AIHW) says over two million people were dispensed respiratory medications in 2013 with most using them only occasionally.

AIHW says the most effective medications for managing asthma, COPD and other obstructive airways disease are underused.9 Many people think they know how to use their asthma inhaler, yet it’s believed up to 90% of people do not use their devices properly.10 Consequently, patients may not be receiving the full benefit of medication. Incorrect use can lead to poor breathing control, sometimes resulting in the patient ending up in hospital.

Many deaths attributed to COPD and asthma are potentially preventable.11 Pharmacists are ideally positioned to demonstrate the easy steps of correct

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

inhaler use. Research shows sufferers need regular reviews or bad habits may return.12 An asthma service study in the UK involving 93 pharmacies showed significant improvement in inhaler technique by virtually all patients.13 In Adelaide pharmacies, a recent pilot of asthma services has shown the increased involvement of pharmacists caring for asthma sufferers can help improve management of their condition.14

GUILDCARE HELPS PHARMACY MANAGE COPD & INHALER TECHNIQUE Unlike other programs, GuildCare helps pharmacies navigate professional service delivery with one seamless software solution.

It’s easy to use and records everything, allowing for patient review and their ongoing management.

GuildCare enables professional collaboration with other health care professionals.

COPD Screening and Inhaler Technique provide multiple prompts or reminders to the pharmacist to either refer the patient to their doctor, or to send a copy of the report about the service. During the service, patients may mention issues they experience which can prompt the pharmacist to refer them back to their doctor. In partnership with Lung Foundation Australia, GuildCare

Training and Education

“Many people think they know how to use their asthma inhaler, yet it’s believed up to 90% of people do not use their devices properly.10”

helps pharmacists perform and document the steps required for COPD screening.

These include identifying patients eligible for screening, populating patient information, measuring spirometry using PIKO-6 or COPD-6, and recording and interpreting the results of measurements. GuildCare prompts at point of dispense to suggest patients who may be eligible. Alternatively, patients can be enrolled ad-hoc.

GuildCare’s Inhaler Technique Check was developed in collaboration with National Asthma Council Australia. It assists pharmacists in assessing patient inhaler technique.

The check identifies, corrects and documents any issues in technique to improve asthma control.

It prompts to suggest potential patients at point of dispense and allows for ad-hoc enrolment of patients using over-the-counter inhalers.

A printout is also provided for the patient.

Videos demonstrating correct inhaler technique for different types of inhalers are easily accessible in GuildCare.

Nicole Floyd is the Queensland Pharmacy Guild’s Professional Services and QCPP Manager. At Asthma Australia’s May Conference, Nicole presented on the role community pharmacy can play in reviewing inhaler technique. She demonstrated GuildCare’s Inhaler Technique Check, telling attendees that “best results are achieved by ensuring staff are well trained”.

“COPD Screening and Inhaler Technique provide multiple prompts or reminders to the pharmacist to either refer the patient to their doctor, or to send a copy of the report about the service.”

references 1 http://www.who.int/mediacentre/factsheets/fs315/en/ 2 http://www.who.int/mediacentre/factsheets/fs315/en/ 3 http://www.who.int/mediacentre/factsheets/fs307/en/ 4 AIHW 2014. Mortality from asthma and COPD in Australia. Cat. no. ACM 30. Canberra: AIHW. 5 Lozano et al. 2012.

6 http://www.healthdata.org/research-article/global-regional-and-national-incidence-prevalence-and-yearslived-disability-2013 7 http://www.nationalasthma.org.au/news-media/d/2015-06-10/winter-asthma-attacks-on-the-rise-warnsasthma-expert 8 Guildlink Data 2014 9 www.aihw.gov.au June 2015 10 http://www.asthmaaustralia.org.au/Puffing_Properly/ 11 AIHW 2014. Mortality from asthma and COPD in Australia. Cat. no. ACM 30. Canberra: AIHW. 12 http://www.asthmaaustralia.org.au/Puffing_Properly/ 13 Page 8 LGC & HSJ supplement 10 June 2015 - www.lgcplus.com/hsj.co.uk 14 Retail Pharmacy June 2015

WHAT GUILDCARE SUPPORT IS AVAILABLE? The GuildCare Support Team can assist with any questions you have in becoming a GuildCare subscriber. Training and technical support is available.

Simply email support@guildcare.com.au or call 1300 647 492 (8 am–6 pm weekdays) and visit www.guildcare.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

39

Health Destination Hub

It was Albert Einstein who said, ‘Try not to become a man of success, but rather a man of value’. Having spent the last few months working in a number of different and busy pharmacies, I have found myself facing a new...

NEW ITKCONNECT.COM.AU

ITK Connect is a new electronic medium designed to interface with community pharmacists on a host of professional, business and industry related topics. The objective is to position content

To register or find out more, please go to

directly to pharmacists in a

www.itkconnect.com.au we would be

timely and consistent format

pleased to include you on our mailing list.

electronically. ITK Connect will be distributed on the alternate month to ITK at no charge, with July.

C O N N E C T

42

Business

The 6CPA

through the eyes of an Industry Expert

Milton Burrell Director of Burrell Consulting MBA, FAIM, GAICD

As I listened to question time, prior to the 6CPA being passed through the Senate, I couldn’t help but think we will have a battle on our hands as we enter the 7CPA negotiations in 2020 if the industry doesn’t put additional checks and balances in place over the next 12 months.

Di Natale was having a crack at the Guild and the Opposition for putting a gun to his head to sign the $18.9b agreement in too short a time. The senator’s concerns stemmed from the failed audit report that came out of the 5CPA and the lack of transparency and accountability across the numbers.

It was riveting listening, I have to say.

Thank goodness for Nick Xenophon’s commentary and industry support.

I think this is a good lesson for the industry, to ensure continued transparency and good governance going forward, not only for the Government, but for Guild members’ comfort.

That said, and on first blush, the 6CPA content appears to be a win for the industry and the Guild, with business certainty preserved for the next five years. So a big tick and congrats to all.

As can be the case with these things, however, it isn’t what is written in the agreement, but what is not written in the agreement that we need to be careful of.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

I won’t go into all the 6CPA elements here as you will have seen the numbers and details by now from the Guild, but I note a couple of red-light-on-the-dash headlines for the industry to watch out for:

•• The $613m funding for continuing Community Pharmacy Programs falls just short of the 5CPA programs funding, but interestingly the funding for year 1 (FY16) is weighted almost 30% of the total. While at this stage only the first year of funding has been allocated, the allocation of subsequent funding will need to be judiciously spent.

Business

••

••

••

••

The Medication Management Programs (CIs, HMRs, RMMRs & MCs) is allocated $178m (down from $249m) and allocated $63m or 36% in Year 1. Likewise the Medication Adherence Programs (DAAs & Staged Supply) has $66m or 35% of its allocation front-ended in FY16.

•• It is worth considering that a professional concern I raise regarding a potentially lonely few recalcitrant operators (that may have gamed the system under 5CPA) re-emerging if checks and balances are not robustly controlled, which I am confident will be the case.

•• Further, don’t be surprised if a major pharmacy group, that was not previously known for its professional programs, all of a sudden develops a very solid DAA program to capitalise on an opportunity.

It is good to see the Rural Support and Aboriginal and Torres Strait Islander programs receive 13% and 11% increases respectively. I am bewildered that only 15%–17% of the five year funding is being allocated to the program in Year 1 — although I’m not sure why it isn’t a simple 20%. Remember, the audit report was scathing due to the lack of transparency in the 5CPA (according to Di Natale!).

I note the CSO has been frozen for the term, so no indexation. Expenses do not freeze, they continue to rise — this suggests to me the wholesalers may need to extract some (future) lost earnings from their customers, just a one-man-survey guess here.

Location Rules, Rx Remuneration and CSO remuneration, all to be reviewed midagreement, makes some sense, however, opens the door for a 7CPA sting in the tail, particularly regarding the location rules given the recent Competition Policy Review.

Pharmacy Remuneration levels are all up, which was good to see; however, the option to discount the patient co-payment by up to $1 will be a trap for some. Pharmacy needs to be careful not to get caught up in this (too early) because you will just be giving away margin. If a pharmacy dispenses (say) 40k co-payment scripts per year and decides to discount each one by $1 due to competitive forces, they will just be giving up $40k in GP and $200k in pharmacy valuation. Why would you do that?

Pharmacy is far better to keep the price up and invest that $40k in other areas to drive foot traffic, improve marketing programs, increase professional service infrastructure etc. Don’t give away the farm too early.

Overall, I believe the 6CPA works for the industry and gives certainty for the next five years.

“On first blush, the 6CPA content appears to be a win for the industry and the Guild, with business certainty preserved for the next five years. So a big tick and congrats to all.”

Continued price disclosure, coupled with increased discounter competition, however, is still putting downward pressure on price and margins and is still the challenge for ongoing viability. However, the Administration Handling and Infrastructure(AHI) fee component of dispensary remuneration within the 6CPA helps to delink from the cost of goods for remuneration and shield for all intents and purposes from any future impacts of price disclosure. The savvy and corporate operators will undoubtedly weave a path through it all; however, small independent operators will continue to struggle. My key tips for mitigating margin shortfall, in no particular order, include:

Measuring GM returns •• Measuring gross margin return on inventory (GMROI), floor space (GMROF) and labour (GMROL) is key to understanding where the margin pressure points are and where to concentrate stock and labour effort.

There are a number of companies who can help you with this, but you need to measure it to know what to do about it.

Generic substitution •• There is a short window of opportunity over the next 1–2 years as price and margin gets close to parity between the generic and branded product (Lipitor a case in point). A pharmacy dispensing 5k scripts a month can earn almost $4k a year by lifting their substitution just 1% point. Imagine if you lift substitution by 5% or 10% points!

Front-of-Shop •• We have all seen a move over the years by the major discounters and larger national players to help offset falling margins in the dispensary by focusing on FOS. New categories also gaining demonstrable traction include superfoods, practitioner only and sports nutrition. Be brutal with aged stock and keep an eye on the tail. If you have FOS stock that’s had a birthday, get rid of it. It’s a sunk cost and owes you nothing, discount it and move it on.

Back Wall •• The same applies to the schedules area — an excellent margin area of focus

for the pharmacist to come out from behind the counter. If you haven’t already seen it, take a look at Nick Logan & RBs “Pharmacy Forward” program for the S3 area — it’s impressive and makes a lot of financial sense. Also, don’t get caught up in discounting, it’s a slippery slope to the bottom — keep prices up for as long as possible, particularly when products come off patent.

Professional programs •• While the amount of MedsChecks were reduced to 10 a month late in the 5CPA due to the gaming by some recalcitrant operators, I am amazed at how many pharmacists didn’t even do the 10.

Likewise NTT and Compliance offer small remuneration opportunities when margins are being squeezed. Throw in some CIs and over a year they pool to offset some much needed profit drop. All the little fish are sweet. As clinical trials become more widespread and fee-for-service becomes the norm, the professional program funding will in time be more important than ever for pharmacy — it is critical that pharmacy is supporting and driving this important area. If you don’t, the major discounters will (and they will anyway).

Better buying and merchandising •• We are seeing a lot of aggregation in the industry as pharmacy groups position themselves for increased market share and improved buying to compete with the major groups. If you are not part of a pharmacy brand or a buying group, you are operating at a disadvantage to the rest of the market. My recommendation is that you join a brand, or at minimum be part of one of the major buying groups. If you are part of a small group of pharmacies (several to a dozen or so), your buying power and trading terms will improve demonstrably if you partner with like-sized groups, have a common brand across the business, and can show suppliers compliance and best-practice merchandising standards.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

43

5 reasons to recommend the Guild Intern Training Program Practical outcomes The Guild Intern Training Program is at the forefront of community pharmacy and provides practical outcomes that are delivered day-to-day.

Flexible course structure The flexible timeline can be tailored to suit your intern’s needs and your pharmacy’s schedule.

Maximum support Interns and preceptors will get maximum support, including workplace visits from Guild clinical tutors.

Attend industry events Interns have access to exclusive networking and learning events including the Australian Pharmacy Professional Conference and Trade Exhibition (APP) on the Gold Coast.

Thorough exam preparation Guild clinical tutors are exam experts who strive to deliver the best exam preparation.

CONTACT YOUR STATE BRANCH FOR MORE INFORMATION NSW & ACT 02 9467 7124 or interntraining@nsw.guild.org.au TAS 03 6220 2955 or interntrainingtas@guild.org.au QLD 07 3831 3788 or intern.training@qldguild.org.au WA 08 9429 4100 or itp@wa.guild.org.au

MAKE THE SWITCH

TO MAXIGESIC

®

MAXIGESIC® is the only combination analgesic that delivers the maximum recommended daily OTC dose of Paracetamol 4000mg and Ibuprofen 1200mg, if required.* HARTLEY ATKINSON, Pharmacologist and Inventor of MAXIGESIC®

} MAXIGESIC® DELIVERS MORE MAXIGESIC® delivers 2.7 times more Paracetamol and 2 times more Ibuprofen than Nuromol®** at maximum recommended daily dosage, if required.* } PROVEN EFFECTIVENESS Clinically proven to reduce pain levels by at least 32% more than a full daily OTC dose of either Paracetamol or Ibuprofen alone1. } SIMPLE, FLEXIBLE DOSAGE REGIMEN 1–2 tablets up to 4 times per day, if required, offers flexibility and control in managing daily pain

* 2 tablets of MAXIGESIC® taken every 6 hours over a 24 hour period ** Nuromol® is a registered trademark of Reckitt Benckiser Group PLC

Please review the full Product Information before recommending, available at www.maxigesic.com.au

DOUBLE ACTION PAIN RELIEF WITHOUT CODEINE References: 1. Merry, A. F., Gibbs, R. D., Edwards, J., Ting, G. S., Frampton, C., Davies, E. and Anderson, B. J. (2010). “Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: a randomized controlled trial” British Journal of Anaesthesia 104(1): 80-88. Result achieved in a trial of post-operative pain relief after removal of 1–4 wisdom teeth using Maxigesic® compared with Paracetamol 4000mg or Ibuprofen 1200mg alone per day in four divided doses.

Maxigesic® film coated tablets (Paracetamol 500mg and Ibuprofen 150mg; 10s, 16s and 30s) are a Pharmacist Only (S3) Medicine for the temporary relief of pain and reduction of fever. The usual dosage for Adults and Children over 12 years is 1-2 tablets taken every 6 hours with a full glass of water, as required, up to a maximum of 8 tablets in 24 hours. Patients should not take more than 8 tablets in a 24 hour period. Incorrect use can be harmful. Do not use in children under 12 years or if patients have kidney disease. Do not use if patients have asthma or a stomach ulcer. Do not combine with any other Paracetamol or Ibuprofen containing medicines. Patent No. 2005260243.

AFT Pharmaceuticals Pty Ltd | Sydney | ABN 29105636413 | WEBSITE www.aftpharm.com FREE PHONE 1800 2387 4276 | FREE FAX 1800 041 026 | EMAIL customer.service@aftpharm.com

46

Health

Pharmacists as Leaders in Chronic Disease Prevention:

The Importance of Promoting Immune Health BY vanessa lontos Founder — The Care Project — Helping build health and wellness services in pharmacy

Chronic diseases are now the leading cause of illness, disability and death in Australia accounting for 90% of deaths in 2011.1 However, it has been estimated that 70–80% of people living with chronic illness could reduce the burden and costs by learning appropriate self-management, how to adopt better ‘health behaviours’ and how to take more responsibility in reducing the progression of these conditions.

Following a report released in 2011 by the World Health Organisation (WHO), the role of the pharmacist has changed progressively over the past two decades, and is now built on two main areas: medication/pharmaceutical advice, and illness and disease prevention. It’s no longer enough to just know about medications, pharmacists now have a responsibility to help prevent chronic disease.

There are many ways for pharmacists to do this and we commonly see a focus on services; however, there is also a more simple strategy that you can implement multiple times per day — engage your prescription customers effectively and expand the conversations you have to include preventive approaches.

The health journey is different for everyone, but regardless of circumstance, it is largely built on behaviour. It is the cumulative effect of the small things someone does each day — such as what they know, how they think, the choices they make, the actions they take, and even the products they choose to use — that ultimately define their level of health. The little things that you say during your ‘encounters at the counters’ can significantly influence a person’s behaviour and therefore disease progression and health outcomes.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

Health

Here are 3 ways to improve your ‘encounters at the counters’ and help you build discussions around immune health:

1

Learn everything you can about the importance of immune health

There is a growing body of evidence demonstrating the importance of immune health and its role in disease prevention.

The immune system, more than any other system in the body, is central to health and wellbeing because it affects every other part of the body. The healthier the immune system, the better the body can cope with the many toxic burdens it may encounter. Conversely, the fewer the toxic burdens, the more effectively the immune system will work.

A well functioning immune system is a balanced immune system. A variety of factors can cause the immune system to be out-of-balance, such as a poor diet, excessive alcohol, little exercise and not enough sleep. Years of chronic low-level inflammation, another indicator of an outof-balance immune system, can contribute to diseases, such as cancer and cardiovascular disease. The immune system is also very sensitive to the stresses of normal life — travel, personal problems, strenuous exercise, and change in diet can all cause imbalances in the immune system and affect overall health.2 Weakening of the immune system results in increased susceptibility to almost every type of illness. Some common signs of impaired immune function include fatigue, repeated infections, inflammation, allergic reactions, slow wound healing, mouth ulcers, oral thrush and chronic diarrhoea.

So, when handing out anti-infectives, antiinflammatories, asthma medication and even diarrhoea medication, remember to focus on immune health as well as the medications.

2

Know your products that benefit immune health intimately

Here are some common pharmacy products that can promote immune balance:3

•• Astragalus – helps immune function and generates anticancer cells in the body.

It’s also a powerful antioxidant

•• Echinacea – helps immune function and enhances lymphatic function.

Studies have shown that Echinacea can be up to 60% more beneficial than placebo

•• Esberitox – is a combination of different herbs that help promote a healthy immune system

•• Vitamins A, C, E and Zinc – are nutrients that are essential for immune health.

Vitamin C is considered the most influential at promoting immune health as it helps in the production of lymphocytes and has a direct effect on bacteria and viruses

3

Engage effectively

Building rapport, being relevant, and showing respect are 3 of the most powerful engagement strategies you can adopt when expanding your conversations. Everyone is on a different health journey, so it’s important to develop a style that allows you to adapt your approach depending on the patient and their immediate needs. Two questions I find useful when handing out medications that would also benefit from ‘an immune health conversation’ are:

•• “Sometimes this medication can affect the way your immune system works.

Would you like to hear more about that?”

•• “Some people on this medication (e.g. antibiotics) also benefit from taking a (insert immune product here, e.g. probiotic). Do you have this at home?”

•• Co Enzyme Q 10 – as an oxygen enhancer it protects cells and heart function

•• Probiotics.

Building conversations around preventive health is both a science and an art and it takes time and practice. Start by focusing on just asking one new question with your patients as you build your knowledge in various areas and you will soon discover that small changes can really make big differences.

Viewed at: www.aihw.gov.au Viewed at: www.embriahealth.com Adapted from Prescription for Nutritional Healing 4th Edition Phyllis A Balch pages: 757–762

1 2 3

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

47

49

New! d n i h Be

d n a Br

the

Quality and timely content is king in pharmacy today.

The new ITK Behind the Brand initiative is presented to Australian Community Pharmacists as an opportunity to allow companies closely aligned with the profession to position product/s, service/s and related content in a detailed manner in one of Australia’s leading pharmacist publications.

Providing information on a company including background, product or service information together with booking forms, training or product content and opportunities to pharmacists has a number of direct and indirect benefits. The primary goal is to educate pharmacists about the position the product and/or service will capture with the profession.

Company Information

3

Product Information

Our guiding principle is to do things better than they’ve been done before.

Whether it’s products ER FORM ORDdeveloping with multiple benefits, creating drug delivery devices that produce less M R FORfor patients, or getting T ORDE AFdiscomfort lower-cost drugs to people with rare y Name:

Pharmac

Combination pain relief without codeine is available in pharmacies, including MAXIGESIC® — a world-first specific combination of Paracetamol 500mg and Ibuprofen 150mg that is now out-licensed in over 40 countries around the world.

r:

Wholesale Date:

Address:

Order Form

Account

Buyer’s

ORDER FOR

No:

M

Name:

DES PDE CO N SYMBIO

API

T PRODUC

c, 10’s Maxigesi l 500mg + mo Paraceta 150mg Ibuprofen c, 16’s Maxigesi l 500mg + mo Paraceta 150mg Ibuprofen c, 30’s Maxigesi l 500mg + mo Paraceta 150mg Ibuprofen

501492

501484

CHS

SIGMA

ESIC MAXIG 135087

150738

135129

150789

150797

135137

346100

346105

346110

$4.55

$5.84

$7.81

6 less 5% 12 less 7.5% 24 less 10%

QTY REQ

$4.32 $4.21 $4.10 $5.55 $5.40 $5.26 $7.42 $7.22 $7.03

Action

RRP

$6.95

4 $8.95

$11.95

e price te. Averag er by Sta T will credit / Wholesal AF by an vary by . Credit Policy: orrectly ces may l GST placed inc aceuticals wil notice. Pri not subject to t ers hou ord rm wit ts turnover . AFT Pha es produc to change subject pricing. *Denot ck return for anyby the pharmacy .

2015 & E lied er /sto ctive July e custom horise a credit d in error via PD te discount app aut Prices effe1st line wholesal ere ropria and will that is ord g with the app ck sto based on rt-dated stock sho not credit processin replace AFT will wholesaler for ployee. to your AFT em this order forward

501468

X FREE F1A026 1800 04 GOLD CRO

.

APPROX OUNT .

NIS APPROX DISCA W/ VI PRICE AVG EX R SALER W/SALE* PRICE

SS PRODU

CTS & SER

VICES PTY

BEHIND the

BRAND

Like to featu re 3 10563641 | ABN 29 s Pty Ltd 276) aceutical M (238 74 AFT Pharm .com AFTPHAR 00 arm 18 ph e: e@aft >> Phon er.servic : custom >> Email

your produ

ct or service For a limited ? time only, IT K is extendin reduced inve g a significan stment to sh tly owcase your exciting new product in initiative Behi nd the Brand. our Please contac

LTD : ITK

ULY 201 : JUNE/J ISSUE 42

5

t Sean Tunn y for more inf e: 04:57ITK GOLD CROSS PRODUCTS & SERVICES Mo PTYbilLTD ormation on 2015 029ISSUE 052 or 43 : AUGUST/SEPTEMBER Email: sean.t unny@gold x.com.au

COMPANY INFORMATION

50

AFT Pharmaceuticals Working to improve your health What’s the company vision for AFT Pharmaceuticals? It’s pretty simple really: to develop innovative products that help people.

Our guiding principle is to do things better than they’ve been done before.

Whether it’s developing products with multiple benefits, creating drug delivery devices that produce less discomfort for patients, or getting lower-cost drugs to people with rare diseases, we’re always focused on improving the status quo and finding opportunities that haven’t been developed before. This allows us to grow as a company, and help meet the health needs of Australians and people all around the world.

We started small — REALLY small.

In 1997, Perth-born pharmacologist, Hartley Atkinson, and his wife, Marree, started AFT Pharmaceuticals in their garage, and hit the road selling products. By 2004, AFT Pharmaceuticals was established in Australia, and with sales this year projected to hit $50 million, the Australian market is now the most significant for a business that is increasingly global in outlook.

Our Australian range of almost 100 prescription and non-prescription products includes unique products such as Maxigesic® — the first Paracetamol/ Ibuprofen combination analgesic introduced to Australia — Hylo®-Fresh, Hylo-Forte® and Coco-Scalp®, plus other well-known pharmacy products like Allersoothe®, Ellgy Plus®, Ferro-Tab®, Ferro-f-tab®, Femme-Tab®, Lorapaed®, Paracetamol Osteo-Tab® and ZoRub®.

We dreamed big and we’ve grown, especially internationally, with offices in Sydney, Singapore, Kuala Lumpur and Auckland, and we now export or license our products to over 40 countries. Plus, our Orphan Drugs Foundation provides access to lowercost pharmaceuticals for people with rare diseases within South-East Asia.

This success has been built on research and development. R&D is at the heart of what we do, whether it’s developing new products or improving

“R&D is at the heart of what we do, whether it’s developing new products or improving existing ones, but it’s also due to the fact that we are close to the market.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

existing ones, but it’s also due to the fact that we are close to the market.

Because we sell our own products, we are constantly looking for changes in health needs and how we can fill gaps that emerge. Our ideas, our researchers, our specialist drug development programmes, and the international experts we partner with, have allowed us to grow significantly year-on-year and forge a place on the world stage in the extremely competitive pharmaceutical industry.

We’re proud of our achievements and ambitious for the future, and you’ll be seeing and hearing much more from us. If you’d like more information about AFT Pharmaceuticals, please visit our new website at www.aftpharm.com or call us on 1800 2387 4276.

PRODUCT INFORMATION

MAKE THE SWITCH TO MAXIGESIC® Codeine has been in the headlines recently, with changes to the scheduling of codeine-based products being considered. But, combination pain relief without codeine is available in pharmacies, including MAXIGESIC® — a world-first specific combination of Paracetamol 500mg and Ibuprofen 150mg that is now out-licensed in over 40 countries around the world.

These are just some of the reasons why Pharmacists should consider making the switch to MAXIGESIC® for customers and patients: • MAXIGESIC® is the only combination analgesic that delivers the maximum recommended daily OTC dose of Paracetamol 4000mg and Ibuprofen 1200mg, if required.* • MAXIGESIC® delivers 2.7 times more Paracetamol and 2 times more Ibuprofen than NUROMOL®** at maximum recommended daily dosage, if required.* • MAXIGESIC® is clinically proven to reduce pain levels by at least 32% more than a full daily OTC dose of either Paracetamol or Ibuprofen alone1.

• The simple, flexible dosage regimen of 1–2 tablets up to 4 times per day, if required, offers flexibility and control in managing daily pain.

• MAXIGESIC® provides the option of combination OTC pain relief without the risks of dependence and misuse that can be associated with codeine-based analgesics.

• Available only in pharmacies, the patented MAXIGESIC® combination cannot be replicated by combining individual OTC products. *Based on 2 tablets of MAXIGESIC® taken every 6 hours over a 24 hour period (8 tablets max.). **NUROMOL® is a registered trademark of Reckitt Benckiser Group PLC.

Visit www.maxigesic.com.au for more information or to review the full Product Information before recommending, or contact AFT Pharmaceuticals (1800 2387 4276) for orders.

References 1 Merry, A. F., Gibbs, R. D., Edwards, J., Ting, G. S., Frampton, C., Davies, E. and Anderson, B. J. (2010). “Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: a randomized controlled trial” British Journal of Anaesthesia 104(1): 80-88. Result achieved in a trial of post-operative pain relief after removal of 1–4 wisdom teeth using Maxigesic® compared with Paracetamol 4000mg or Ibuprofen 1200mg alone per day in four divided doses.

MAXIGESIC® film coated tablets (Paracetamol 500mg and Ibuprofen 150mg; 10s, 16s and 30s) are a Pharmacist Only (S3) Medicine for the temporary relief of pain and reduction of fever. The usual dosage for Adults and Children over 12 years is 1–2 tablets taken every 6 hours with a full glass of water, as required, up to a maximum of 8 tablets in 24 hours.

Patients should not take more than 8 tablets in a 24 hour period. Incorrect use can be harmful. Do not use in children under 12 years or if patients have kidney disease. Do not use if patients have asthma or a stomach ulcer. Do not combine with any other Paracetamol or Ibuprofen containing medicines. Patent No. 2005260243.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

51

ORDER FORM

52

MAXIGESIC® Order Form Pharmacy Name: Wholesaler: Date: Address: Account No: Buyer’s Name:

PDE CODES PRODUCT

API

SYMBION

SIGMA

CHS

APPROX. DISCOUNT APPROX. AVG EX VIA W/ NIS W/SALER SALER PRICE PRICE *

QTY REQ

RRP

MAXIGESIC Maxigesic, 10’s Paracetamol 500mg + Ibuprofen 150mg

501492

150738

135087

346100

$4.55

Maxigesic, 16’s Paracetamol 500mg + Ibuprofen 150mg

501484

150789

135129

346105

$5.84

Maxigesic, 30’s Paracetamol 500mg + Ibuprofen 150mg

501468

150797

135137

346110

$7.81

6 less 5% 12 less 7.5% 24 less 10%

$4.32 $4.21 $4.10

$6.95

$5.55 $5.40 $5.26

$8.95

$7.42 $7.22 $7.03

$11.95

Prices effective July 2015 & subject to change without notice. Prices may vary by Wholesaler by State. Average price based on 1st line wholesale customer pricing. *Denotes products not subject to GST. Credit Policy: AFT will credit/ replace short-dated stock and will authorise a credit/stock return for any turnover orders placed incorrectly by an AFT employee. AFT will not credit stock that is ordered in error via PDE by the pharmacy. AFT Pharmaceuticals will forward this order to your wholesaler for processing with the appropriate discount applied.

FREE FAX

1800 041 026

AFT Pharmaceuticals Pty Ltd | ABN 29105636413 >> Phone: 1800 AFTPHARM (238 74276) >> Email: customer.service@aftpharm.com

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

53

d n i h Be the

d n a r B

Like to feature your product or service?

For a limited time only, ITK is extending an invitation to health partners to showcase your product/service in our new Behind the Brand feature, at a significantly reduced price.

Please contact Sean Tunny for more information on Mobile: 0457 029 052 or Email: sean.tunny@goldx.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

GOLD COAST CONVENTION & EXHIBITION CENTRE

17-20 MARCH Australian Pharmacy Professional Conference & Trade Exhibition

MARK YOUR DIARY! SESSIONS 17-20 MARCH / TRADE 18-20 MARCH

www.appconference.com

PS

pp

Product Insight

Do you want more dispenses each day?

HEALTHNOTES IS THE #1 SCRIPT MANAGEMENT SOFTWARE FOR PHARMACIES IN AUSTRALIA. IT IS USED BY 1 IN 4 AUSTRALIAN PHARMACIES TO MANAGE THE PRESCRIPTION MEDICATIONS OF OVER 1 MILLION CUSTOMERS. OVER 4,000 GENERAL PRACTITIONERS ARE ALSO CONNECTED WITH HEALTHNOTES THROUGH GP CONNECT. USING HEALTHNOTES, PHARMACIES ARE ABLE TO REALISE 4–5 MORE DISPENSES PER CUSTOMER PER ANNUM.

NE

Healthnotes has many powerful and automated features that enable pharmacies to maximise dispenses by increasing customer loyalty and substantially improving their medication compliance. These features are:

•• Sending Script Reminders to which •• •• •• ••

customers can respond Tracking customers’ scripts and compliance and flagging problems Sending targeted, tailored messages to improve medication compliance Sending Script Requests to General Practitioners Delivering Pharmacy Professional Services.

SENDING SCRIPT REMINDERS Remind your customers when their next repeat is due or overdue, when the last repeat was dispensed, or when a script is owing or has expired. With Healthnotes:

•• Reminders can go out via SMS, landline or push notifications within the Healthnotes App •• In response to an SMS or app reminder, customers can reply via either channel with requests to order their medication •• The average improvement is 4.5 more scripts per customer per year.

TRACKING SCRIPTS & COMPLIANCE Engage customers face to face on the basis of personalised reports about their scripts dispensed.

•• The Patient Medication Compliance Report shows the compliance score per patient per medication •• You can use this report to have a discussion with the patient about their medication compliance •• The Script Tracker report allows tracking of lost potential (total sales) when dispensary customers don’t return to your pharmacy

•• Using Healthnotes in this way, pharmacies

•• Avoids loss of script revenue

are recovering up to 60% of customers not returned in the last 3 months.

whilst maintaining continuity of therapy for customers.

SENDING TARGETED, TAILORED MESSAGES

DELIVERING PROFESSIONAL PHARMACY SERVICES

Engage with customers of targeted medications through preset campaigns within Healthnotes.

•• Deliver professional services

•• Customers of the targeted medications automatically receive regular SMS messages (e.g. 1 per fortnight or 1 per month) about the importance of medication compliance and handy tips to remain compliant •• A campaign targeting customers of a prescription medication for Asthma within Healthnotes has increased their medication compliance by 25% over 6 months •• A campaign targeting customers of a prescription medication for smoking cessation within Healthnotes has increased the customers’ return rate to pharmacies by 13% over 2 months.

SENDING SCRIPT REQUESTS TO GENERAL PRACTITIONERS VIA GP CONNECT Through GP Connect in Healthnotes, GPs can review and approve script requests, generate prescriptions, and download script receipts.

•• Receive timely prescriptions from General Practitioners by seamlessly sending them script requests for medications due to be dispensed (or already dispensed) to customers in Residential Aged Care Facilities (RACF), or with Dose Administration Aids (DAAs), or on an owing script basis •• In 2014 pharmacies using Healthnotes sent 1 million prescription requests to >4,000 GPs on behalf of 35,000 customers

(e.g. Clinical Interventions, MedsChecks, Diabetes MedsChecks) to engage and educate your customers. Healthnotes enables you to manage the end-to-end customer interaction, from identifying the customers, to promoting the services, to recording consultations and setting up follow-ups.

SETTING UP •• If you already have Healthnotes and would like to have the new products, please call us for a free trial 03 8692 0015. This offer is available until 31 Dec 2015 •• If you do not have Healthnotes, sign up at www.healthnotes.com.au and let us take care of everything. We install the software onto your dispense computers and train your staff. It’s quick and easy.

ENROLLING CUSTOMERS •• The more customers you have in Healthnotes, the more you (and they) benefit. We help you with staff training and in-store marketing collateral to enrol your customers. We put a little bit of magic into your pharmacy.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

55

56

Product Insight

MEDIHONEY

®

A World Leader in Natural Wound Healing 1.0 INDICATION

4.0 PREGNANCY & BREASTFEEDING

Q. What is the product used for?

A short outline of condition.

Q. Can the product be used in pregnancy and breastfeeding?

A. MEDIHONEY® Antibacterial Wound Gel™ is a clinically proven medical device containing medical grade antibacterial Manuka honey.

It is a sterile gel that promotes wound healing and reduces the risk of infection.

A. MEDIHONEY® Antibacterial Wound Gel™ can be used on minor wounds during pregnancy and breastfeeding.

MEDIHONEY Antibacterial Wound Gel™ can be used on all minor wounds, including eczema skin splits and cracked skin, cuts, ulcers, burns, grazes, sores and cracked heels.

Q. Are there any side effects to be aware of, or is the product well tolerated?

®

2.0 MODE OF ACTION Q. How does it work?

•• Creates a lower wound pH to facilitate healing

•• Cleans and debrides the wound due to its high osmolarity

•• Promotes a moisture-balanced wound environment conducive to wound healing

•• Reduces the risk of infection from bacteria •• Reduces wound malodour •• Reduces wound trauma at dressing change

3.0 PRECAUTIONS, CONTRAINDICATIONS and INTERACTIONS Q. Are there any patients who would not benefit from this product, e.g. children?

A. MEDIHONEY® Antibacterial Wound Gel™ is suitable for use by the whole family, for use on all minor wounds. It is an essential for household first aid kits.

5.0 SIDE EFFECTS

A. MEDIHONEY® Antibacterial Wound Gel™ is very well tolerated, even among people with sensitive skin. There are no side effects associated with using MEDIHONEY® Antibacterial Wound Gel™ for the treatment and management of minor wounds.

6.0 COMPARATIVE INFORMATION Q. Where does this product sit with the current treatments available?

A. Over-the-counter topical preparations for wounds are not typically designed for cleaning and debridement of wounds. MEDIHONEY® Antibacterial Wound Gel™ creates a high osmotic potential due to its low water, high sugar content. Excess water from exudate and interstitial oedema is drawn away from the wound by osmosis. This continual outflow of wound fluid cleanses the wound of debris and bacteria, and facilitates autolytic debridement of slough and necrotic tissue1,2.

Serious wounds should be managed under the supervision of a healthcare professional.

Q. Are there any drug interactions or drug-condition interactions.

A. MEDIHONEY® Antibacterial Wound Gel™ has no known medicine interactions or medicine-condition interactions.

MEDIHONEY® Antibacterial Wound Gel™ is supported by over 130 clinical papers and scientific case studies. The product has been available since 1999, with 15+ years of safety and efficacy data supporting its use.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

Q. How is it different or better than other treatments?

A. MEDIHONEY® Antibacterial Wound Gel™ is a clinically proven medical device that contains medical grade antibacterial Manuka honey. This is the only species of honey that has been shown in randomised controlled studies to help wounds that have stalled under first-line treatment, to progress towards healing. It is unique among all types of honey in that it maintains its effectiveness even in the presence of wound fluid.

Medical grade Manuka honey has the ability to modulate the pH of the wound environment, restoring an acidic environment conducive to healing3. When the honey is diluted by wound fluid, glucose is converted into gluconic acid, maintaining a low pH. Medical grade antibacterial Manuka Honey has an average pH of 3.9.

An acidic wound pH has been shown to have many benefits, such as increasing wound oxygenation, enhancing the activity of macrophages and fibroblasts, decreasing wound size, inhibiting growth of wound pathogens and regulating protease activity4.

7.0 COUNSELLING POINTS Q. How is this product used?

A. Keeping the surface of wounds moist is one of the most important aspects of effective wound management. It is important to always cover wounds with a dressing. Creating a moist environment will encourage the wound to heal faster and with less scarring. Dressings also help to reduce pain and discomfort, and lessen the risk of infection.

Wash hands and clean the wound.

Apply MEDIHONEY® Antibacterial Wound Gel™ onto a clean dressing that is appropriate for covering the wound. Use enough Wound Gel to cover the wound area to a depth of 3 mm.

Cover the wound with the dressing. Change the dressing daily until healed.

Serious wounds should only be treated under the supervision of a registered healthcare practitioner, such as a GP or a specialist wound care nurse.

Product Insight

Principal Antibacterial Modalities of Comvita® MEDIHONEY® Antibacterial Wound Gel™ Methylglyoxal

A powerful broad spectrum antimicrobial agent unique to honey from Leptospermum sp. Dihydroxyacetone, found in Manuka nectar, is gradually converted to methylglyoxal upon storage.

Low pH

Average pH 3.9. pH is buffered by continual production of gluconic acid when honey is diluted with wound fluid.

Low pH helps inhibit wound pathogens.

Hydrogen Peroxide

A broad spectrum antiseptic produced at very dilute, non-toxic concentrations when glucose oxidase acts on glucose in diluted honey.

Low water/High sugar

Water concentration is around 17%. H2O is bound to glucose molecules with average available water (Aw) of 0.6, depriving bacteria of the water essential for their survival. Low water content also creates strong osmotic potential, drawing bacteria away from the wound into the antibacterial dressing matrix.

REFERENCES 1 Robson V. Leptospermum honey used as a debriding agent. Nurse 2 Nurse.

2002;2(11);66-8.

2 Gethin G, Cowman S. Manuka honey vs. hydrogel – a prospective, open label, multicentre, randomised controlled trial to compare desloughing efficacy and healing outcomes in venous leg ulcers. J Clin Nurs. 2009;18(3):466-474.

3 Gethin GT, Cowman S, Conroy RM. The impact of Manuka honey dressings on the surface pH of chronic wounds. Int Wound J. 2008;5(2):185-94.

4 Gethin GT. The significance of surface pH in chronic wounds. Wounds UK. 2007;3(3):52-6.

“Medical grade Manuka honey has the ability to modulate the pH of the wound environment, restoring an acidic environment conducive to healing3.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

57

58

Product Insight

Betadine Sore Throat Care How can Betadine help your sore throat this winter?

What are the differences between the products in the Betadine Sore Throat Gargle range?

A sore throat may be mild and annoying, or it may be severe enough to affect a person’s ability to eat, drink and speak.

There are several causes of a sore throat, the most common of which is a bacterial or viral infection of the pharynx.1 Sore throats are the second most common reason people seek medical treatment 2, but it is difficult to determine whether a sore throat is viral or bacterial from symptoms alone.

Betadine Sore Throat Gargle is available in both Concentrate and Ready to Use formulas.

To reduce the likelihood of developing a sore throat this winter, it is important to strengthen your immune defences by maintaining a healthy diet and lifestyle.

The following tips may help:

•• Wash hands thoroughly and frequently •• Avoid close contact with people who are •• ••

••

••

sick (Common sense we know, but always a good reminder!)

Humidify your home or office if the air is dry, and rug up rather than rely on heaters Increase consumption of fresh fruit and vegetables especially vitamin C-rich capsicum, citrus fruits, strawberries, and green leafy vegies, such as broccoli Consume adequate amounts of fluids especially water, but also include green or herbal tea, vegetable juices and warm soups Maintain a regular exercise routine

Product

Contents

Pack sizes

Dose per pack

Betadine Concentrated Throat Gargle

Povidone-iodine 7.5% (contains ethanol)

15mL 40mL

15 doses 40 doses

Betadine Ready To Use Sore Throat Gargle

Povidone-iodine 1%

120mL

8 doses

How do I use Betadiane Sore Throat Gargles?

Betadine Sore Throat Gargle Concentrate: This solution is concentrated and therefore must be diluted. Dilute 1mL solution to 20mL of water using the measuring cup provided and gargle for 30 seconds. Repeat every 3–4 hours if necessary.

Do not swallow.

Betadine Ready to Use Sore Throat Gargle: This solution does not need to be diluted. Pour 15mL liquid into the measuring cup provided and gargle for 30 seconds. Repeat every 3–4 hours if necessary. Do not swallow.

What can I do to treat a sore throat?

Betadine Sore Throat Gargle contains povidone-iodine, a powerful antiseptic.

Betadine kills the bacteria that can cause a sore throat, rather than simply masking the symptoms and can be used at the first sign of a sore throat. Betadine works quickly, in fact laboratory studies have shown povidone-iodine is able to kill certain bacteria within 30 seconds.3

“To reduce the likelihood of developing a sore throat this winter, it is important to strengthen your immune defences by maintaining a healthy diet and lifestyle.”

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

A severe sore throat accompanied by fever, headache, nausea or vomiting, or any sore throat that lasts for more than 2 days may be serious. In these cases, always consult a healthcare practitioner.

Betadine also offer a sore throat lozenge.

Betadine Sore Throat Lozenges work differently to Betadine Sore Throat Gargle. They are iodine-free and help to kill the bacteria which can cause sore throat and mouth infections.

Lozenges are also more convenient to use throughout the day, and combined with Betadine Sore Throat Gargle, they help Treat and Relieve a sore throat.

Always read the label and use only as directed. If symptoms persist, consult your healthcare professional. ® BETADINE is a Registered Trademark.

Oxford Concise Medical Dictionary, E.A. Martin, Oxford, 2003, p 641 Danchin M. The burden of group A streptococcal pharyngitis in Melbourne families. Indian J Med Res 119 (Suppl) May 2004, pp 144–147 3 Shiraishi T and Nakagawa Y. Evaluation of the bactericidal activity of povidine-iodine and commercially available gargle preparations.

Dermatology. 2002;204(1): 37–41 1

2

Product Insight

Putting the Pro in Probiotics In your store over the past decade, you will have noticed an influx of probiotic supplements.

But can you confidently recommend the right probiotic for the right condition? Are you familiar with the stability issues with unsatisfactory storage conditions, and can you explain this to your customers when they are seeking a ‘shelf-stable’ probiotic? Not all probiotic supplements are manufactured the same, nor have the same health benefits. Let’s put the pro in probiotics.

Does the probiotic you currently recommend identify the strains used in the formula?

Image of probiotic bacteria: Lactobacillus acidophilus species

Although not currently mandatory in Australia, a good quality probiotic should clearly identify which strain is used. Check your labels.

The strain should be expressed in brackets after the genus and species name, such as exclusive Lactobacillus acidophilus (NCFM®) found in Inner Health Plus.

Different probiotic strains exert different health benefits with varying strengths and limitations, which is why it is important to know when to recommend each strain.

For example — the Lactobacillus plantarum (299v) strain has been shown to reduce the symptoms of medically diagnosed irritable bowel syndrome, whereas the strain Lactobacillus plantarum (HEAL 9) has been shown to reduce the frequency, severity and duration of colds.

Although from the same genus and species, these strains are indicated for two very different conditions.

Is the probiotic refrigerated to ensure bacteria remain alive?

Probiotics are live organisms which require complete care to keep them that way. Heat and temperature variations (such as a store turning the air conditioner on and off every day) cause probiotics to activate prematurely and lose potency. This is why a controllable, stable environment like a fridge is best for probiotic longevity. But it’s not just refrigeration in-store that’s important — keeping a temperaturecontrolled environment at every stage of manufacture, storage and in transit (with ice packs for protection from overheated delivery vans) is just as imperative. Shelf stored?

The fridge is the most temperature-stable shelf in your store.

“Different probiotic strains exert different health benefits with varying strengths and limitations, which is why it is important to know when to recommend each strain.”

Has the probiotic been manufactured by an expert probiotic manufacturer?

Ethical Nutrients and Inner Health Plus manufacture their own probiotics in a $40 million facility in Brisbane. Manufacturing in-house, and not outsourcing to contract manufacturers, ensures quality control over the whole process. Furthermore, three full-time microbiologists test probiotics before, during and after manufacture.

Take back to store •• Check the strains on your labels •• Choose evidence-based formulas •• Recommend the right dose for the right condition

•• Check where the formula has been manufactured

•• Refrigeration is best for probiotics

Always read the label. Use only as directed.

If symptoms persist consult your healthcare professional.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

59

60

Product Insight

Helping Your Customers Stay Well This Winter!

Winter can be a wonderful time of year with its cold weather, winter woollies, open fires and hearty foods. Unfortunately, winter is also cold and flu season and, with most people’s lives being so busy, they need to squeeze every last minute out of the day — there’s no time to be sick.

Ethical Nutrients Immune Defence contains an exclusive formula supporting the immune system, and reducing the severity and duration of colds and flu. This product contains a combination of potent herbs including: Andrographis (King of Bitters), Siberian Ginseng, Echinacea, BCM-95® Turmeric, Zinc and Vitamin A. Herbal remedies may help support the functioning of your customers’ immune

system and in Traditional Chinese Medicine, the herbs Andrographis, Echinacea and Siberian Ginseng have a history of being used to keep the immune system healthy throughout winter.

Ethical Nutrients Immune Defence contains these ingredients which may help keep your customers’ immune systems firing, so they can come out on top in the health stakes this winter.

For the maintenance of your customers’ immune system, simply recommend 1 tablet of Ethical Nutrients Immune Defence daily, and if your customers don’t have time to be sick, recommend 1 tablet twice daily to help relieve their cold and flu symptoms, and keep them well this winter season.

T ER S I G ER REGISTW RE O

N OW N

EXPLORE EXPLORE

NEW

17-19 September 2015 September 2015 Etihad17-19 Stadium, Melbourne Etihad Stadium, Melbourne

MEET THE CHALLENGES MEET THE CHALLENGES THROUGH INNOVATION THROUGH INNOVATION In a challenging environment there are always opportunities Inand a challenging environment there are always opportunities PBN2015 will examine and highlight how to meet these and PBN2015 will examine and highlightthrough how to meet these challenges innovation. challenges through innovation.

PBN2015 will deliver practical hands-on workshops, PBN2015 deliver and practical hands-on workshops, inspiringwill speakers, networking opportunities inspiringthat speakers, networking opportunities will beand worthwhile for all current and thataspiring will be worthwhile for all and pharmacy owners,current pharmacy aspiring pharmacy owners, pharmacy and retail managers, key pharmacy staff, students, and retail managers, key pharmacy students, interns and pharmacy industrystaff, stakeholders. interns and pharmacy industry stakeholders.

NOT A SINGLE CLINICAL SESSION...GUARANTEED! NOT A SINGLE CLINICAL SESSION...GUARANTEED!

POWER YOUR BUSINESS POWER YOUR BUSINESS

NEW SERVICES SERVICES IMPROVE IMPROVE BUSINESS BUSINESS EFFICIENCY EFFICIENCY CONVERT CONVERT

NEW

NEW CUSTOMERS CUSTOMERS INCREASE INCREASE

BUSINESS BUSINESS PERFORMANCE PERFORMANCE

Follow the PBN2015 conversation at Follow the PBN2015 conversation at

DEVELOPING LEADERS AND OWNERS IN PHARMACY DEVELOPING LEADERS AND OWNERS IN PHARMACY

@PharmacyBN @PharmacyBN

PHARMACY BUSINESS NETWORK PHARMACY BUSINESS NETWORK

www.pharmacybusinessnetwork.com www.pharmacybusinessnetwork.com

63

what’s new & company news ``HERBS & NATURAL SUPPLEMENTS, 4TH EDITION AVAILABLE NOW With emerging practice areas changing the role of the pharmacist in the Australian healthcare system, the holistic approach to medicine is something that you need to stay informed on. Written by Lesley Braun, PhD, BPharm, DipAppSciNat and Marc Cohen, MBBS(Hons), PhD, BMedSc(Hons), FAMAC, FICAE, this two volume resource is essential to the safe and effective use of herbal, nutritional and food supplements.

“GP education, as part of a multidisciplinary team approach including pharmacists, is key to diabetes care and management in Australia.”

– Dr Gary Deed, General Practitioner, Queensland

The 4th Edition has been updated with the latest evidence base given the exponential growth in peer-reviewed literature that has occurred since the last edition and has been specially designed to support you in your day-to-day practice.

•• Emphasises safe practice with strategies to prevent adverse drug reactions, guidelines in assessing benefit, risk and harm and the evaluation of research

•• Provides current, evidence-based monographs on the 132 most popular herbs, nutrients and food supplements To find out more, visit elsevierhealth.com.au and apply promo code HERBS20 for an exclusive 20% discount!* *Apply special 20% discount and free delivery promo code: HERBS20 at checkout stage.

Offer ends 31/12/2015.

Prices are subject to change without notice.

``Sanofi urges Government to co-fund diabetes education for GPs

Sanofi, the number one diabetes healthcare company in Australia1, is calling on the Federal Government to join them to co-fund a GP diabetes education program aimed at reducing a growing financial burden on Australia’s healthcare system. The call comes as research finds 60 percent of Australians with type 2 diabetes are not meeting their blood glucose levels.2,3

The education program, developed jointly with endocrinologists, GPs, diabetes educators, pharmacists and Sanofi outlines how, by bringing blood glucose levels to target, GPs can play a key role in cutting future costs on healthcare by reducing the likelihood and severity of diabetes-related complications. >> www.sanofi.com.au

References: 1. Based on MiPortal MAT figures, 2015. Diabetes Market – MAT to March 2015, F1 only. Published in Pharma in Focus on 8 March 2015.

2. Davis TM, Davis WA, Bruce DG. Glycaemic levels triggering intensification of therapy in type 2 diabetes in the community: the Freemantle Diabetes Study. Med J Aust 2006; 184: 325-8.

3. Del Prato S, Felton AM, Munro N, Nesto R, Zimmet P Zinman B. Improving glucose management: ten steps to get more patients with type 2 diabetes to glycaemic goal. Int J Clin Pract 2005;59:1345–55.

``Introducing a mucosal delivery system that’s got oral pain covered.

MucoLox™

Mouth ulcers – whether from dental procedures, cancer treatment, autoimmune disorders or other causes – can be incredibly painful, and even keep patients from eating and drinking. And they’re notoriously hard to treat, as most preparations have the tendency to wash away with saliva.

MucoLox is a revolutionary base that delivers unprecedented staying power.

It can be used alone or with active pharmaceutical ingredients (APIs) to help deliver long-lasting adhesion for mouth ulcers and other mucosal conditions.

MucoLox’s one-of-a-kind polymer network brings improved moisturisation and protection, but won’t easily wash away, bonding to the mucosa to create a powerful but lightweight coating effect. When used

with APIs, MucoLox’s advanced adhesive properties help create the gradual and continued release of the API, leading to improved contact time of the API to the mucosa.

MucoLox is exclusively available from PCCA Member compounding pharmacies. >> www.pccarx.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

64

what’s new & company news

``Johnson & Johnson launcheS “so much more” Johnson & Johnson has launched “so much more”, a global movement that highlights the importance of sensorial stimulation in baby’s early life.

By just three years of age, 85 % of baby’s brain is formed. Research suggests that during this time, sensorial stimulation can be critical to baby’s happy, healthy development.

Johnson’s Global Baby bath Time Report reveals that routine touch, massage, along with sights, sounds and smells help support baby’s growth and development. Infants that “Sharing beautiful experiences like bath time, touch, massage and even verbal communication will not only create special

“Pleasant smells, when paired with the loving interactions of a parent can create lasting memories children will remember for a lifetime.”

moments between parent and child, but stimulate their baby’s brain as well” said Dr Ginni Mansberg.

As the #1 baby skin care brand and pioneer of research on baby skin, JOHNSON’S is now exploring the role of multi-sensorial experiences that make bath time a ritual that can be more than just cleansing.

The everyday rituals parents create become more powerful when multiple senses, like smell and touch, are stimulated.

Pleasant smells, when paired with the loving interactions of a parent can create lasting memories children will remember for a lifetime. >> www.johnsonsbaby.com.au

``GARLIC RESEARCH GETS HEART PUMPING Aged Garlic Extract™ (AGE) may help to reverse the fatty deposits around the heart and reduce calcification in the arteries plus lower-blood pressure, according to breakthrough research.1 Professor of Medicine, Harbor-UCLA Medical Centre, Dr Matthew Budoff states that AGE helps to reduce soft plaque within the arteries. Studies show that most heart attacks are caused by soft plaque which is an inflamed part of an artery that can burst.

AGE also decreases diastolic blood pressure and slows the progression of coronary artery calcification. Therefore, garlic may prove useful for patients who are at high risk of future cardiovascular events.

These include S-allyl cysteine (SAC), a watersoluble sulfur compound that is characteristic of Kyolic® Aged Garlic Extract™. SAC is easily absorbed by the body unlike the volatile oilsoluble compounds found in raw garlic.

Several previous clinical studies have shown AGE may inhibit the progression of atherosclerosis, lower blood pressure, improve oxidative stress and enhance circulation.

120 caps RRP $55.99

Aged Garlic Extract™ has active compounds that aren’t found in fresh garlic or other products that use fresh garlic extract or garlic powder.

>> http://www.wagnerhealth.com.au/ learning-centre/kyolic-learning-centre

content.onlinejacc.org/data/Journals/ JAC/933568/14723.pdf

1

``Toll Manufacture Technology Consulting Support Wild Child Laboratories is a new facility based in Malaga Western Australia.

Primarily established to produce its own range of products the company now offers toll manufacture for medium to high volume products runs. The company is currently manufacturing class 1 therapeutic devices and high quality cosmetic and personal care products in a clean room environment and is ideally positioned to produce high quality cosmetic and personal care products.

We have a portfolio of more than 200 cosmetic, personal care, therapeutic device and medicines ranging from pre-operative disinfectants to coloured lip balms.

Core competencies are in the areas of:

•• Research and Development

Wild Child Laboratories works in close collaboration with their customers to help them develop and bring new products to market. We formulate, develop and manufacture skin care and over the counter pharmaceuticals for the global market place.

•• Manufacturing

A highly qualified team of experts with a combined experience of over 30 years along with a passion for fine products and necessary industry experience to meet the client’s requirements. Site inspections are welcome.

•• Testing

>> www.wildchild.com.au

•• Formulation •• Regulatory Affairs •• Packaging

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

what’s new & company news

``LEO PHARMA’S DAIVONEX® CREAM

(calcipotriol 50μg/g) DELISTED FROM PBS

Daivonex® cream (50μg/g), indicated for the treatment of chronic stable plaque type psoriasis vulgaris in adults, was delisted from the PBS on 1st June 2015.

The availability of newer and more effective products such as Daivobet® 50/500 gel and ointment (calcipotriol 50μg/g/ betamethasone as dipropionate 500μg/g)1,2 has caused a decline in the use of Daivonex® cream. As such, LEO Pharma decided that this product was no longer viable at the current PBS price. It remains available on private prescription at an expected price of $45.00*.

Alternative therapies are available on the PBS including LEO Pharma’s Daivobet® 50/500 gel and ointment which have superior efficacy compared to either calcipotriol or a corticosteroid used alone.1,2 Prescribers or healthcare professionals with any questions are encouraged to speak to their local LEO Pharma representative or contact LEO Pharma’s QualityCare™ Patient Support Service on 1800 094 104 (during AEST business hours) or via email at qualitycare. au@leo-pharma.com >> www.leo-pharma.com.au

“The availability of newer and more effective products such as Daivobet® 50/500 gel and ointment (calcipotriol 50μg/g/ betamethasone as dipropionate 500μg/g)1,2 has caused a decline in the use of Daivonex® cream.”

Daivobet® 50/500 ointment. Australian Product Information. Updated 30/06/2013.

Daivobet® 50/500 gel. Australian Product Information. Updated 22/03/2013. * indicative cost at online pharmacies at the time of print and subject to change 1 2

PRODUCT SPOTLIGHT 60 SECONDS WITH...

I decided to become a pharmacist because...

I was good at chemistry and Pharmacy was only a 3 year degree but mostly I wanted to help people.

I have been working as a pharmacist for...

23 years.

What I like best about my job is...

The buzz you get by making a real difference for someone and kicking a professional goal.

My favourite hobby is...

Mountain Biking and training for Adventurethons; kayak, mountain bike and trail run.

My favourite book is...

Alan Patterson

Magnetic Island Pharmacy

The Narnia series got me reading but How to Kill a Mockingbird is my all-time favourite.

My best getaway ever was...

Trekking the Annapurna /Dhaulagiri cicuit in Nepal with my sister.

How I keep myself updated to the market news...

Guild media release, Pharmacy Daily and Pharmacy Alliance updates.

Over the next 3 years in pharmacy, I predict...

Great innovation from pharmacy as we look to differentiate ourselves and serve the public professionally instead of pursuing deadly discounting.

If I could give any advice to someone starting a career in pharmacy, it would be...

Get out on the floor before you have to!

Learn OTC and learn from assistants.

When you are a pharmacist you will be expected to know! Don’t leave it for someone else and follow through.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

65

66

PRODUCT SPOTLIGHT

PRODUCT SPOTLIGHT ``HEALTHNOTES App LAUNCHED! Keep your customers plugged in to their medication requirements with the user-friendly Healthnotes app for iPhone and Android. The app links directly in to your Healthnotes software and gives your customers quick access to order meds, view meds history, manage family members’ meds, or message the pharmacy.

It’s mobile medication made easy!

FREE with Healthnotes software until December 31st 2015 *Conditions apply >> 03 8692 0015 >> www.healthnotes.com.au

``QUITNITS 10 MINUTE SOLUTION One of Australia’s leading head lice brands for 18 years.

Works in just 10 minutes.

•• •• •• •• ••

Scientifically Tested Low irritant formula Non flammable Includes nit comb Suitable for pregnant & nursing mothers

``Introducing a mucosal delivery

system that’s got oral pain covered.

MucoLox™ Dental procedures, cancer treatment, autoimmune disorders and other conditions can cause incredibly painful mouth ulcers, and even keep you from eating and drinking.

But MucoLox™ can help. Here’s how: Bonding polymers create better adhesion and increased contact time delivers more APIs to affected areas

>> www.wildchild.com.au MucoLox™ compounded with APIs

Mucus membrane

>> www.pccarx.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

Mouth ulcer

PRODUCT SPOTLIGHT

``MEDIHONEY® NATURAL ECZEMA CREAM Comvita’s unique Eczema cream is carefully formulated to help soothe and relieve eczema skin irritations and flare ups. It contains quality natural ingredients, including medical grade antibacterial Manuka honey, Aloe vera and Chamomile. This products is dermatologically tested and independently certified by the Natural Products Association™ (NPA). >> www.comvita.com.au

``Murine Eye Mist New Betadine Sore Throat Lozenges helps to kill the bacteria which can cause sore throats. Helps provide fast, soothing and effective relief from the discomfort of sore throats. Iodine free, available in great tasting soothing honey & lemon, fresh menthol & eucalyptus and orange flavours.

Always read the label. Use only as directed. If symptoms persist, consult your healthcare professional.

ASMI 24387-0115 >> www.betadine.com.au

``NICORETTE® Cooldrops Lozenges Nicorette Cooldrops Lozenges are discreet and flexible to help people with hectic lifestyles stay on top of nicotine cravings and other withdrawal symptoms. NICORETTE® 2mg Cooldrops are the Best Tasting Lozenge*#. * Amongst leading lozenge brands. # Data on File - Nicotine Lozenge Preference Test, 14th June 2010 - 2mg lozenge >> www.nicorette.com.au

``CLINICALLY SHOWN TO HELP REDUCE THE FREQUENCY AND DURATION OF COLDS Inner Health Immune Booster for Adults is a probiotic that may help boost immune system function in adults and help reduce the frequency, severity and duration of colds.

Study in Swedish population.

Sponsored by Probi AB. Always read the label. Use only as directed.

If symptoms persist consult your healthcare professional. >> www.ethicalnutrients.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

67

68

After Hours

AFTER HOURS...

Sydney Spring Carnival

12 September – 17 October the 2015 Sydney Spring Racing Carnival runs from August through to early October at both Rosehill and Randwick racecourses in Sydney, headlined by the Epsom Handicap in October.

The Carnival has almost $9 million in prize money up for the taking, over the four month period, and includes six exciting Group 1 races. The first Group 1 race of the carnival is also arguably the most prestigious, with the running of the $1 million Golden Rose, taking place in the sixth week of the carnival in early September at Rosehill Racecourse. Other leading races that attract the best gallopers in the country include the George Main Stakes, The Epsom Handicap and The Metropolitan.

The Sydney Spring Racing Carnival kicks off at Royal Randwick Racecourse in August with the Group 2 Missile Stakes, with the Group 3 Summer Cup on Boxing Day at the same venue concluding the event. The carnival spans across city and provincial racecourses in and around Sydney, including Rosehill, Royal Randwick, Warwick Farm and Newcastle.

The Rosehill Spring Carnival The Rosehill Spring Carnival is one of five conducted during the Sydney Spring Racing Carnival. Included in the event is the biggest and richest race of the carnival, the $1 million Group 1 Golden Rose for three-year-olds.

Mid-August is the first major event of spring for Rosehill Racecourse, that being the San Domenico Stakes Day. Other leading days in the event include Run To The Rose Day and Stan Fox Stakes Day.

The Royal Randwick Spring Carnival The Royal Randwick Spring Carnival boasts most of the quality races during the Sydney Spring Racing Carnival, including five Group 1s. Three of those Group 1s fall are scheduled for the headline event, Epsom Handicap Day. Almost $2 million in prize money is up for grabs on that day in early October, and that’s more than any other event during the Sydney spring.

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

The Warwick Farm Spring Carnival The Warwick Farm Spring Carnival includes the racecourse’s biggest event on the racing calendar. The Warwick Stakes Day kicks off the carnival in late August and boasts a racecard that includes five Group races, headlined by the Group 2 Warwick Stakes.

The Newcastle Spring Racing Carnival The Newcastle Spring Racing Carnival is held over a two-day period in mid-September, shortly after the running of the Golden Rose.

The event consists of two days, those being Cameron Handicap Day on a Wednesday and Newcastle Gold Cup Day on a Thursday.

The headline event of the carnival is the $175,000 Group 3 Newcastle Gold Cup, an Open Handicap over 2300 m at the Newcastle Racecourse.

HEALTH CALENDAR

HEALTH CALENDAR AUGUST/SEPTEMBER 2015 Donate Life Week 2nd – 9th August DonateLife Week is the national awareness week to promote organ and tissue donation in Australia.

DonateLife Week provides a timely reminder to all Australians of the need to discuss their donation decision with loved ones, and to ask and know their donation decisions. It’s a week dedicated to having the chat that saves lives. Family discussion and knowledge of donation decisions is vital. The majority of families say that having discussed and knowing the donation decision of their loved one made it much easier to support donation proceeding. Rarely, does a family decline donation if they knew the deceased’s wishes. >> www.donatelife.gov.au

Women’s Health Week

Hearing Awareness Week

7th – 11th September

23rd – 29th August Hearing loss can be caused by hereditary conditions, infectious diseases, prolonged exposure to excess noise and effects of ageing.

An estimated 3.5 million Australians are affected to varying degrees, half of whom are of a working age.

Only 10-20% of people who could benefit from a hearing aid wear them. If you’re concerned that you may be losing your hearing, tackling the problem early can improve both your hearing and your quality of life, including your relationships. People who are fitted with hearing aids early are likely to get more benefit from them than those who put up with hearing loss for years before seeking help.

Women’s Health Week is an online event providing women with a range of engaging opportunities to learn about their health including videos, articles, podcasts, local community events and the latest evidence-based information from health experts. During the week, we encourage you to think about ways you can improve your health and we give you ideas and practical tips to get you started. >> www.womenshealthweek.com.au

R U OK Day? 10th September

>> www.hearingawarenessweek.org.au

Daffodil Day 28th August Each day more than 115 Australians will die of cancer. Daffodil Day raises funds for Cancer Council to continue its work in cancer research, providing patient support programs and prevention programs for all Australians. Daffodil Day helps grow hope for better treatments and more survivors. To Cancer Council, the daffodil represents hope for a cancer-free future. You too, can help in the fight against cancer by wearing a Cancer Council pin this Daffodil Day. Daffodil Day merchandise is on sale throughout July and August, and you can donate to Daffodil Day at any time.

R U OK? is a not-for-profit organisation founded

by Gavin Larkin in 2009, whose vision is a world where we’re all connected and are protected from suicide. Accordingly, our mission is to encourage and equip everyone to regularly and meaningfully ask “are you ok?” We know that suicide prevention is an enormously complex and sensitive challenge the world over. But we also know that some of the world’s smartest people have been working tirelessly and developed credible theories that suggest there’s power in that simplest of questions - “Are you ok?” >> www.ruok.org.au

>> daffodilday.com.au GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

69

70

Business directory

Business Directory AFT Pharmaceuticals Level 1, 296 Burns Bay Road Lane Cover NSW 2066 Tel: 02 9420 0420 >> www.aftpharm.com

Gold Cross Level 3, 10 National Circuit Barton ACT 2600 Tel: 02 6270 8950 >> www.goldx.com.au

RB Australia 44 Wharf Road West Ryde NSW 2114 Tel: 1800 226 766 >> www.rbhealthhub.com.au

Johnson & Johnson Pacific 45 Jones St Ultimo 2007 Tel: Consumer Care Centre 1800 029 979 >> www.nicorette.com.au

Bayer

Wild Child

Head Office PO Box 903 875 Pacific Highway Prumble NSW 2073 Tel: 02 9391 6000 >> www.bayer.com.au

2 Action Road Malaga, WA 6090 Tel: 08 9249 3553 >> www.wildchildcosmeceuticals.com

Kimberly-Clark Australia 52 Alfred Street Milsons Point NSW 2061 Tel: 1800 028 334 >> www.kimberly-clark.com.au

Care Pharmaceuticals Suite 302 Level 3 75 Grafton Street NSW 2022 Tel: 02 9300 1900 >> www.carepharma.com.au

LEASE1 Retailer House – Level 1, Unit 3 321 Kelvin Grove Road Kelvin Grove QLD 4059 Tel: 1300 766 369 >> www.lease1.com.au

Comvita 10 Edmondstone Street South Brisbane QLD 4101 Tel: 1800 466 392 >> www.comvita.com.au

FLOWSELL 1/13 Network Drive Carrum Downs VIC 3201 Tel: (61-3) 9708 2276 >> www.flowsell.com.au

Would you like to advertise in our new Business Directory?

HEALTH WORLD 741 Nudgee Road Northgate QLD 4013 Tel: 07 3117 3300 >> www.healthworld.com.au

PCCA 1/ 73 Beauchamp Road Matraville, NSW 2036 Australia Tel: 1300 722 269 >> www.pccarx.com.au

GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 43 : AUGUST/SEPTEMBER 2015

Contact Jess O’Connor on Ph: 07 3040 4415 or Email: jessica.oconnor@goldx.com.au

NEW & IMPROVED Natural Eczema Care Range From Comvita® the world’s largest producer of Manuka honey

NEW

Larger Size 50g

NEW Improved Formula

Formulated with a combination of proven, natural ingredients The key ingredient – medical grade Manuka honey – is used in hospitals around the world Dermatologically tested for sensitive, dry & eczema prone skin The only natural eczema care products independently certified by the Natural Products AssociationTM (NPA) Specific products for specific eczema care needs Includes products for broken & infected skin, as well as intact skin Free from synthetic fragrances & colours Pleasant, low-scent aroma - great for kids & sensitive noses Suitable for the whole family

www.comvita.com.au

Our TV ADVERTISING draws customers to your store.

Our TRAINING

enables you to give them the best advice.

Our COMMITMENT

to you ensures they come back to you!

MAKING QUALITY PROBIOTICS FOR ISN’T CHILDS PLAY Leave it to the probiotic experts.

Inner Health for Kids is an exclusive probiotic for children that can be taken every day to help improve their general wellbeing and can be recommended for children taking a course of antibiotics to assist in maintaining their levels of friendly bacteria.

For children who get sick often, the probiotic strains in Inner Health Immune Booster for Kids have been clinically shown to reduce the frequency and severity of cold and flu symptoms.

Inner Health for Kids and Inner Health Immune Booster for Kids are only available from Pharmacies and Health Food stores, where your customers can receive informed advice; and you can be sure they come back to you, not a nearby supermarket.

ethicalnutrients.com.au BEST PRODUCTS BEST EDUCATION Industry Pulse independent research shows Ethical Nutrients, yet again, Ind BEST SERVICE a as the leading supplier to Pharmacy providing unparalleled service excellence and product training for the 5th consecutive year!

Ethical Nutrients offers professional natural medicine training for all staff in your store in a variety of formats to suit the varied needs of your staff: • Online Learning Modules • In-Store Trainings • Training Evenings • itherapeutics.com.au For qualified Naturopathic support contact our technical team on 1800 777 648.

IHP3257 - 05/15

YOUR NATURAL BUSINESS PARTNER